MEDICARE: DR. HOLLY BOWEN EGGEBRAATEN WESTBROCK D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4943	MN

General Provider Information

NPI Number	:	1346361797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOLLY BOWEN EGGEBRAATEN WESTBROCK D.C.

Provider Business Mailing Address
First Line	:	9112 EDGEWOOD CIR
Second Line	:
City	:	SHAKOPEE
State	:	MN
Zip	:	55379-8514
Country	:	US
Telephone Number	:	952-479-0043
Fax Number	:

Provider Business Practice Location Address
First Line	:	8577 COLUMBINE RD
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7662
Country	:	US
Telephone Number	:	952-479-0043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	09/23/2010

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