Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 7099 | TX |
NPI | 1417954033 |
---|---|
Provider Name | Dr. Peggy J Bolks |
First Address | Spring, TX 77379-8123 |
Second Address | Spring, TX 77379-8123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2005 |
Last Update Date | 19/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TO4928 | (02) | TX |