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General NPI Number Information
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NPI Number | 1902997703
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Entity Type | Organization
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Legal Business Name | BOONE FAMILY CHIROPRACTIC AND WELLNESS, PLC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 12630 43RD ST NE
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-8432
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Country | US
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Telephone | 763-232-4303
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Fax |
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Provider Business Mailing Address
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Address Line | 12630 43RD ST NE
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-8432
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Country | US
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Telephone | 763-232-4303
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. STACY M BOONE-VIKINGSON
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Credential | D.C.
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Telephone | 763-232-4303
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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 | 4815
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License Number State | MN
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