Basic Information
| Provider Information | |||||||||
| NPI: | 1215266978 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOLLINGER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | LEROY | ||||||||
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| Credential: | H.I.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 904 THOMPSON BLVD | ||||||||
| Address2: | |||||||||
| City: | SEDALIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 653012241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608263700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 915 SOUTHWEST BLVD | ||||||||
| Address2: | F | ||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651095014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735568700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2009 | ||||||||
| LastUpdateDate: | 03/31/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 2008036746 | MO | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.