Provider Demographics
NPI:1063808236
Name:BOLANDER, CHRISTOPHER (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:BOLANDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:360-629-1500
Mailing Address - Fax:360-629-1513
Practice Address - Street 1:7205 265TH ST NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6221
Practice Address - Country:US
Practice Address - Phone:360-629-1500
Practice Address - Fax:360-629-1513
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAOP60866847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program