Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1549 | MN |
NPI | 1003974148 |
---|---|
Provider Name | Charles Thomas Boisen |
First Address | Rochester, MN 55901 |
Second Address | Rochester, MN 55901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 02/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T78396 | (02) |