Provider Demographics
NPI:1063149326
Name:BOKMAN, MARIAH LYNN (DC)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:LYNN
Last Name:BOKMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 TWELVE OAKS CENTER DR STE 640
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-4502
Mailing Address - Country:US
Mailing Address - Phone:952-378-1085
Mailing Address - Fax:
Practice Address - Street 1:600 TWELVE OAKS CENTER DR STE 640
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4502
Practice Address - Country:US
Practice Address - Phone:952-378-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor