Pro Active Chiropractic

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

DC29572 Issued in CA

Legal business name

PRO ACTIVE CHIROPRACTIC

Doing business as

David Bolton

Practice address

340 S Glendora Ave
Suite #4
Glendora, CA 91741-6255

Phone

(626) 335-1007

Fax

(626) 335-1002

NPI assigned

May 27, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. David Lowell Bolton, DCNPI 1730371238

Title

Owner, Chiropractor

Phone

(626) 335-1007

Specialties & licenses 1

Addresses

Other names 1

• David Bolton Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David L Bolton, D.C.

  • Chiropractor
  • Glendora, CA
  • NPI 1730371238
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306454400000",
    "number": "1467745190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 S GLENDORA AVE",
            "address_2": "SUITE #4",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917416255",
            "telephone_number": "626-335-1007",
            "fax_number": "626-335-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 S GLENDORA AVE",
            "address_2": "SUITE #4",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917416255",
            "telephone_number": "626-335-1007",
            "fax_number": "626-335-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO ACTIVE CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-27",
        "last_updated": "2011-05-27",
        "status": "A",
        "authorized_official_last_name": "BOLTON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "LOWELL",
        "authorized_official_title_or_position": "OWNER, CHIROPRACTOR",
        "authorized_official_telephone_number": "626-335-1007",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "CA",
            "license": "DC29572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "David Bolton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Sports Physician Chiropractor in Glendora, CA
• Providers in Glendora, CA by specialty
• Sports Physician Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.