Healthcare Provider Details

I. General information

NPI: 1386682383
Provider Name (Legal Business Name): DENIS BOERJAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W 4TH ST
SAINT ANSGAR IA
50472-1316
US

IV. Provider business mailing address

1724 37TH ST NW
ROCHESTER MN
55901-4228
US

V. Phone/Fax

Practice location:
  • Phone: 641-713-2168
  • Fax: 641-713-3168
Mailing address:
  • Phone: 507-424-1200
  • Fax: 507-288-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1344
License Number StateMN

VIII. Authorized Official

Name: DR. DENIS BOERJAN
Title or Position: CHIEF MEMBER
Credential: D.C.
Phone: 507-424-1200