Provider Demographics
NPI:1194071696
Name:BORUD, CATHERINE JEAN HENGEL (DC)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:JEAN HENGEL
Last Name:BORUD
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 1:623 N CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MN
Mailing Address - Zip Code:56762-1005
Mailing Address - Country:US
Mailing Address - Phone:701-367-2947
Mailing Address - Fax:
Practice Address - Street 1:104 E HIGHWAY 66
Practice Address - Street 2:SUITE 4
Practice Address - City:DRAYTON
Practice Address - State:ND
Practice Address - Zip Code:58225-4804
Practice Address - Country:US
Practice Address - Phone:701-454-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5676111N00000X
ND920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND03174Medicare PIN