MEDICARE: DR. ASSIAT BJADTOEVA BOKE DC

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	4589	MN

General Provider Information

NPI Number	:	1942521638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASSIAT BJADTOEVA BOKE DC

Provider Business Mailing Address
First Line	:	951 TRENTON LN N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55441-4426
Country	:	US
Telephone Number	:	952-220-9250
Fax Number	:

Provider Business Practice Location Address
First Line	:	5851 DULUTH ST STE 301
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-3957
Country	:	US
Telephone Number	:	763-522-0044
Fax Number	:

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

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	06/16/2010

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