Provider Demographics
NPI:1992803910
Name:BOLZ, TIMOTHY D (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:BOLZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 SW 21ST
Mailing Address - Street 2:STE1
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-3890
Mailing Address - Country:US
Mailing Address - Phone:785-231-7339
Mailing Address - Fax:785-272-2671
Practice Address - Street 1:4990 SW 21ST ST
Practice Address - Street 2:STE 1
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3890
Practice Address - Country:US
Practice Address - Phone:785-272-2090
Practice Address - Fax:785-272-2671
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103769111N00000X
KS01-03769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS023710OtherBLUE CROSS BLUE SHIELD
350011505OtherRAILROAD MEDICARE
KS023710OtherBLUE CROSS BLUE SHIELD
017535Medicare ID - Type Unspecified