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NPI Code Detail

MEDICARE: DR. STACY MARIE BOONE-VIKINGSON D.C.

MEDICARE: DR. STACY MARIE BOONE-VIKINGSON 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
1111N00000XChiropractor4815MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
144-03165OTHERMNMEDICA
2701555OTHERMNOPTIMUM HEALTH
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
409N91BOOTHERMNBLUE CROSS BLUE SHIELD OF MINNESOTA

General Provider Information

NPI Number : 1487682274
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACY MARIE BOONE-VIKINGSON D.C.
Provider Business Mailing Address
First Line : 2501 W 84TH ST
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55431-1602
Country : US
Telephone Number : 952-855-5444
Fax Number : 952-886-7561
Provider Business Practice Location Address
First Line : 2501 W 84TH ST
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55431-1602
Country : US
Telephone Number : 952-885-5444
Fax Number : 952-886-7561
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 11/10/2016

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