Provider Demographics
NPI:1144312471
Name:BOLINE CHIROPRACTIC
Entity type:Organization
Organization Name:BOLINE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-631-3003
Mailing Address - Street 1:11 BRYANT AVE SW
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1405
Mailing Address - Country:US
Mailing Address - Phone:218-631-3003
Mailing Address - Fax:
Practice Address - Street 1:11 BRYANT AVE SW
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1405
Practice Address - Country:US
Practice Address - Phone:218-631-3003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C907BOOtherBCBS
MNHP21779OtherHEALTH PARTNERS
MN230981OtherCHIROCARE