Provider Demographics
NPI:1366637092
Name:BOYD, ROSE ELLEN SHULTZ (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:ELLEN SHULTZ
Last Name:BOYD
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 1:9426 MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-4197
Mailing Address - Country:US
Mailing Address - Phone:563-343-8841
Mailing Address - Fax:
Practice Address - Street 1:1310 E. WAYZATA BVLD
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1952
Practice Address - Country:US
Practice Address - Phone:952-473-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor