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General NPI Number Information
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NPI Number | 1518039072
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Entity Type | Organization
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Legal Business Name | BOLLINGBERG CHIROPRACTIC CLINIC LLP
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 704 OAKLAND AVE W
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City | AUSTIN
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State | MN
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Zip | 55912-2318
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Country | US
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Telephone | 507-433-4013
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Fax | 507-433-4026
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Provider Business Mailing Address
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Address Line | 704 OAKLAND AVE W
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City | AUSTIN
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State | MN
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Zip | 55912-2318
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Country | US
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Telephone | 507-433-4013
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Fax | 507-433-4026
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. FAYE E BOLLINGBERG
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Credential | D.C.
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Telephone | 507-433-4013
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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 | 02933
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License Number State | MN
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