Provider Demographics
NPI:1245237064
Name:BOEN, BRIAN J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:BOEN
Suffix:
Gender:M
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:PO BOX 169
Mailing Address - Street 2:210 HIGHWAY AVENUE
Mailing Address - City:BIRD ISLAND
Mailing Address - State:MN
Mailing Address - Zip Code:55310-0169
Mailing Address - Country:US
Mailing Address - Phone:320-365-4635
Mailing Address - Fax:320-365-3237
Practice Address - Street 1:210 HIGHWAY AVE
Practice Address - Street 2:
Practice Address - City:BIRD ISLAND
Practice Address - State:MN
Practice Address - Zip Code:55310-0169
Practice Address - Country:US
Practice Address - Phone:320-365-4635
Practice Address - Fax:320-365-3237
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00B79BOOtherBLUE CROSS & BLUE SHIELD
MN662670OtherCHIRO CARE
MN662670OtherCHIRO CARE