Provider Demographics
NPI:1225612583
Name:BOULTON, WHITNEY LYNN (DC)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LYNN
Last Name:BOULTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 CAZADOR LN # C
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-6643
Mailing Address - Country:US
Mailing Address - Phone:916-337-1404
Mailing Address - Fax:949-359-8386
Practice Address - Street 1:300 S EL CAMINO REAL STE 202
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4070
Practice Address - Country:US
Practice Address - Phone:949-232-0523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor