MEDICARE: DR. BRIANNA BOLIVER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC011253	PA

General Provider Information

NPI Number	:	1336674704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIANNA BOLIVER D.C.

Provider Business Mailing Address
First Line	:	310 S CHESTNUT ST
Second Line	:
City	:	DERRY
State	:	PA
Zip	:	15627-1220
Country	:	US
Telephone Number	:	724-694-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 S CHESTNUT ST
Second Line	:
City	:	DERRY
State	:	PA
Zip	:	15627-1220
Country	:	US
Telephone Number	:	724-694-9700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2017
Last Update Date	:	04/24/2017

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