MEDICARE: MR. GARY EUGENE BOLEN DC

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	CH7387	FL

General Provider Information

NPI Number	:	1467568816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY EUGENE BOLEN DC

Provider Business Mailing Address
First Line	:	4107 SOUTH TAMIAMI TRAIL
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293
Country	:	US
Telephone Number	:	941-497-7424
Fax Number	:	941-493-8413

Provider Business Practice Location Address
First Line	:	4107 SOUTH TAMIAMI TRAIL
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293
Country	:	US
Telephone Number	:	941-497-7424
Fax Number	:	941-493-8413

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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