Provider Demographics
NPI:1386682383
Name:DENIS BOERJAN, LLC
Entity type:Organization
Organization Name:DENIS BOERJAN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOERJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-424-1200
Mailing Address - Street 1:1724 37TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-4228
Mailing Address - Country:US
Mailing Address - Phone:507-424-1200
Mailing Address - Fax:507-288-3249
Practice Address - Street 1:417 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ANSGAR
Practice Address - State:IA
Practice Address - Zip Code:50472-1316
Practice Address - Country:US
Practice Address - Phone:641-713-2168
Practice Address - Fax:641-713-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty