Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 3458 | MN |
NPI | 1205913274 |
---|---|
Provider Name | Dr. Troy A Boschee |
First Address | Savage, MN 55378-2340 |
Second Address | Bloomington, MN 55437-2700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
266219100 | (05) | MN |
U69507 | (02) | MN |