Healthcare Provider Details

I. General information

NPI: 1699768655
Provider Name (Legal Business Name): DENIS BOERJAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 37TH ST NW
ROCHESTER MN
55901-4228
US

IV. Provider business mailing address

PO BOX 250
SAINT ANSGAR IA
50472-0250
US

V. Phone/Fax

Practice location:
  • Phone: 507-424-1200
  • Fax: 507-288-3249
Mailing address:
  • Phone: 641-736-2168
  • Fax: 641-713-3168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA05898
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: