Provider Demographics
NPI:1093240772
Name:XIONG, BAO (DC)
Entity Type:Individual
Prefix:DR
First Name:BAO
Middle Name:
Last Name:XIONG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 WHITE BEAR AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-1608
Mailing Address - Country:US
Mailing Address - Phone:651-800-5030
Mailing Address - Fax:888-394-0236
Practice Address - Street 1:1618 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-1608
Practice Address - Country:US
Practice Address - Phone:651-800-5030
Practice Address - Fax:888-394-0236
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor