Individual
DR. MICHAEL JOHN BOTHOF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
16154 MAIN AVE SE STE 134A, PRIOR LAKE, MN 55372-4815
(952) 447-3000
(952) 447-3561
Mailing address
16298 HARMONY PATH, LAKEVILLE, MN 55044-6310
(952) 953-4740
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3631
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44-02425
MEDICA
MN
01
—
44-02426
MEDICA PROVIDER #
MN
01
—
640618
ACN CHIROCARE
MN
05
—
642613100
—
MN
01
—
870G2BO
BLUE CROSS BLUE SHIELD MN
MN
01
—
HP58905
HEALTH PARTNERS ID#
MN
Enumeration date
11/07/2006
Last updated
06/24/2008
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