Organization
BOONE FAMILY CHIROPRACTIC AND WELLNESS, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACY M BOONE-VIKINGSON D.C. (CEO)
(763) 232-4303
Entity
Organization
Contact information
Practice address
12630 43RD ST NE, SAINT MICHAEL, MN 55376-8432
(763) 232-4303
Mailing address
12630 43RD ST NE, SAINT MICHAEL, MN 55376-8432
(763) 232-4303
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4815
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09N81BO
BLUE CROSS BLUE SHIELD OF MINNESOTA
MN
01
—
44-03165
MEDICA
MN
05
—
634620200
—
MN
01
—
701555
OPTIMUM HEALTH
MN
Enumeration date
09/27/2006
Last updated
11/10/2016
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