Provider Demographics
NPI:1962950469
Name:BORSHEIM CLINIC PLLC
Entity type:Organization
Organization Name:BORSHEIM CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WORNER
Authorized Official - Last Name:BORSHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-740-5832
Mailing Address - Street 1:7114 SHADY OAK RD
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344
Mailing Address - Country:US
Mailing Address - Phone:952-943-2404
Mailing Address - Fax:952-943-2400
Practice Address - Street 1:3915 TRAIL POINT CT NW
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-4118
Practice Address - Country:US
Practice Address - Phone:701-740-5832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty