Active NPI
Patrick Edward Bolerjack, DC
- Chiropractor
- Metairie, LA
National Provider Identifier
1619041928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 717
- Practice address
- 4503 Clearview Pkwy
Metairie, LA 70006-2307 - Phone
- (504) 885-9700
- Fax
- (504) 885-8760
- NPI assigned
- Nov 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 717 | LA | Primary |
Addresses
Primary practice location
4503 Clearview Pkwy
Metairie, LA 70006-2307
Mailing address
4503 Clearview Pkwy
Metairie, LA 70006-2307
Phone (504) 885-9700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1935697 | Medicaid | LA |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266883200000",
"number": "1619041928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4503 CLEARVIEW PKWY",
"city": "METAIRIE",
"state": "LA",
"postal_code": "700062307",
"telephone_number": "504-885-9700",
"fax_number": "504-885-8760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4503 CLEARVIEW PKWY",
"city": "METAIRIE",
"state": "LA",
"postal_code": "700062307",
"telephone_number": "504-885-9700",
"fax_number": "504-885-8760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLERJACK",
"first_name": "PATRICK",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2010-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "LA",
"license": "717",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1935697",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Metairie, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.