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General NPI Number Information
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NPI Number | 1861427197
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Entity Type | Individual
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Provider Name | ANDREA ELLIE BOLOGNA DC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4540 BELT LINE ROAD
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City | ADDISON
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State | TX
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Zip | 75001
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Country | US
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Telephone | 972-789-9333
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Fax | 972-789-9557
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Provider Business Mailing Address
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Address Line | 10429 N MACARTHUR BLVD APT 161
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City | IRVING
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State | TX
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Zip | 75063
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Country | US
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Telephone | 214-801-2977
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 10196
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License Number State | TX
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