Individual
DR. STACY MARIE BOONE-VIKINGSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
2501 W 84TH ST, BLOOMINGTON, MN 55431-1602
(952) 885-5444
(952) 886-7561
Mailing address
2501 W 84TH ST, BLOOMINGTON, MN 55431-1602
(952) 855-5444
(952) 886-7561
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4815
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09N91BO
BLUE CROSS BLUE SHIELD OF MINNESOTA
MN
01
—
44-03165
MEDICA
MN
05
—
469667900
—
MN
01
—
701555
OPTIMUM HEALTH
MN
Enumeration date
06/29/2006
Last updated
11/10/2016
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