Active NPI
Courtney Bolduc
- Chiropractor
- Maitland, FL
National Provider Identifier
1053893719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH12518
- Practice address
- 100 E Sybelia Ave Ste 140
Maitland, FL 32751-4750 - Phone
- (407) 627-0090
- NPI assigned
- Aug 29, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH12518 | FL | Primary |
Addresses
Primary practice location
100 E Sybelia Ave Ste 140
Maitland, FL 32751-4750
Mailing address
100 E Sybelia Ave Ste 140
Maitland, FL 32751-4750
Phone (407) 627-0090
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH12518 | FL | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gena M Bofshever, DC, LLC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739404800000",
"number": "1053893719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 E SYBELIA AVE STE 140",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327514750",
"telephone_number": "407-627-0090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E SYBELIA AVE STE 140",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327514750",
"telephone_number": "407-627-0090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLDUC",
"first_name": "COURTNEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-29",
"last_updated": "2025-02-13",
"certification_date": "2025-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH12518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maitland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.