Healthcare Provider Details

I. General information

NPI: 1942521638
Provider Name (Legal Business Name): ASSIAT BJADTOEVA BOKE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5851 DULUTH ST STE 301
GOLDEN VALLEY MN
55422-3957
US

IV. Provider business mailing address

951 TRENTON LN N
PLYMOUTH MN
55441-4426
US

V. Phone/Fax

Practice location:
  • Phone: 763-522-0044
  • Fax:
Mailing address:
  • Phone: 952-220-9250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4589
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: