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General NPI Number Information
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NPI Number | 1215127808
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Entity Type | Organization
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Legal Business Name | BOLEN CHIROPRACTIC, PA
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/16/2012
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Provider Practice Location Address
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Address Line | 2730 PIEDMONT AVE
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City | DULUTH
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State | MN
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Zip | 55811-6710
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Country | US
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Telephone | 218-728-3630
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Fax | 218-786-0399
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Provider Business Mailing Address
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Address Line | 2730 PIEDMONT AVE
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City | DULUTH
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State | MN
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Zip | 55811-6710
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Country | US
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Telephone | 218-728-3630
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Fax | 218-786-0399
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC/ PRESIDENT
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Name | DR. TROY CHRISTOPHER BOLEN
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Credential | D.C.
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Telephone | 218-728-3630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5673
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3323
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License Number State | MN
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