MEDICARE: DR. TROY CHRISTOPHER BOLEN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3323	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	411877532	OTHER	MN	FIRST PLAN OF MINNESOTA
3	231988	OTHER	MN	CHIROPRACTIC CARE OF MN
4	411877532	OTHER	MN	EPIC
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	411877532	OTHER	MN	PREFERRED ONE
7	5C085BO	OTHER	MN	BCBSMN

General Provider Information

NPI Number	:	1013912195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TROY CHRISTOPHER BOLEN D.C.

Provider Business Mailing Address
First Line	:	2730 PIEDMONT AVE
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-6710
Country	:	US
Telephone Number	:	218-728-3630
Fax Number	:	218-786-0399

Provider Business Practice Location Address
First Line	:	2730 PIEDMONT AVE
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-6710
Country	:	US
Telephone Number	:	218-728-3630
Fax Number	:	218-786-0399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/03/2008

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Directions to “ DR. TROY CHRISTOPHER BOLEN D.C.” Practice Location

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