Provider Demographics
NPI:1013912195
Name:BOLEN, TROY CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:CHRISTOPHER
Last Name:BOLEN
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 1:2730 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-6710
Mailing Address - Country:US
Mailing Address - Phone:218-728-3630
Mailing Address - Fax:218-786-0399
Practice Address - Street 1:2730 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-6710
Practice Address - Country:US
Practice Address - Phone:218-728-3630
Practice Address - Fax:218-786-0399
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN838818100Medicaid
MN411877532OtherFIRST PLAN OF MINNESOTA
MN231988OtherCHIROPRACTIC CARE OF MN
MN411877532OtherEPIC
WI38911400Medicaid
MN411877532OtherPREFERRED ONE
MN5C085BOOtherBCBSMN
MNU61121Medicare UPIN
MN350001998Medicare ID - Type UnspecifiedMEDICARE
MN838818100Medicaid