Provider Demographics
NPI:1194259846
Name:BOLTJES, ZACHARY STEVEN
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:STEVEN
Last Name:BOLTJES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-4048
Mailing Address - Country:US
Mailing Address - Phone:712-255-5511
Mailing Address - Fax:712-277-1336
Practice Address - Street 1:2608 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-4048
Practice Address - Country:US
Practice Address - Phone:712-255-5511
Practice Address - Fax:712-277-1336
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor