Healthcare Provider Details

I. General information

NPI: 1205913274
Provider Name (Legal Business Name): TROY A BOSCHEE D.C., C.C.S.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 NORMANDALE BLVD
BLOOMINGTON MN
55437-2700
US

IV. Provider business mailing address

8351 CARRIAGE HILL ALCOVE
SAVAGE MN
55378-2340
US

V. Phone/Fax

Practice location:
  • Phone: 952-888-5805
  • Fax: 952-888-7563
Mailing address:
  • Phone: 952-445-3608
  • Fax: 952-888-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3458
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: