Provider Demographics
NPI:1609997006
Name:BOEN CHIROPRACTIC PA
Entity Type:Organization
Organization Name:BOEN CHIROPRACTIC PA
Other - Org Name:HEALTH ENHANCEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BOEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-365-4635
Mailing Address - Street 1:210 HIGHWAY AVE
Mailing Address - Street 2:PO BOX 169
Mailing Address - City:BIRD ISLAND
Mailing Address - State:MN
Mailing Address - Zip Code:55310
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
Practice Address - Country:US
Practice Address - Phone:320-365-4635
Practice Address - Fax:320-365-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1245237064OtherNPI
MN1245237064OtherNPI