Provider Demographics
NPI:1942521638
Name:BJADTOEVA BOKE, ASSIAT (DC)
Entity Type:Individual
Prefix:DR
First Name:ASSIAT
Middle Name:
Last Name:BJADTOEVA BOKE
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 1:951 TRENTON LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-4426
Mailing Address - Country:US
Mailing Address - Phone:952-220-9250
Mailing Address - Fax:
Practice Address - Street 1:5851 DULUTH ST STE 301
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3957
Practice Address - Country:US
Practice Address - Phone:763-522-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor