Provider Demographics
NPI:1518039072
Name:BOLLINGBERG CHIROPRACTIC CLINIC LLP
Entity Type:Organization
Organization Name:BOLLINGBERG CHIROPRACTIC CLINIC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOLLINGBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-433-4013
Mailing Address - Street 1:704 OAKLAND AVE W
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2318
Mailing Address - Country:US
Mailing Address - Phone:507-433-4013
Mailing Address - Fax:507-433-4026
Practice Address - Street 1:704 OAKLAND AVE W
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-2318
Practice Address - Country:US
Practice Address - Phone:507-433-4013
Practice Address - Fax:507-433-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN224817400Medicaid
MN61D10BOOtherBCBS
MN61D10BOOtherBCBS
MNU31794Medicare UPIN