Active NPI
Kelvin Lamont Bolar
- Chiropractor
- Orange Park, FL
National Provider Identifier
1144784067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH12689
- Practice address
- 1218 Park Ave
Orange Park, FL 32073-4152 - Phone
- (904) 269-2437
- Fax
- (904) 264-2330
- NPI assigned
- Jan 24, 2019
- Last updated
- Jan 24, 2019
- Sex
- Male
- 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 | CH12689 | FL | Primary |
Addresses
Primary practice location
1218 Park Ave
Orange Park, FL 32073-4152
Mailing address
1218 Park Ave
Orange Park, FL 32073-4152
Phone (904) 269-2437
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH12689 | FL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548288000000",
"number": "1144784067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1218 PARK AVE",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320734152",
"telephone_number": "904-269-2437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1218 PARK AVE",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320734152",
"telephone_number": "904-269-2437",
"fax_number": "904-264-2330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLAR",
"first_name": "KELVIN",
"middle_name": "LAMONT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-01-24",
"last_updated": "2019-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH12689",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.