MEDICARE: BOLLINGBERG CHIROPRACTIC CLINIC LLP

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	02933	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	61D10BO	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1518039072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOLLINGBERG CHIROPRACTIC CLINIC LLP

Provider Business Mailing Address
First Line	:	704 OAKLAND AVE W
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912-2318
Country	:	US
Telephone Number	:	507-433-4013
Fax Number	:	507-433-4026

Provider Business Practice Location Address
First Line	:	704 OAKLAND AVE W
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912-2318
Country	:	US
Telephone Number	:	507-433-4013
Fax Number	:	507-433-4026

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. FAYE E BOLLINGBERG
Credential	:	D.C.
Telephone Number	:	507-433-4013

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	03/13/2012

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