Provider Demographics
NPI:1447378146
Name:BOESER, LISA LYNN (DC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:BOESER
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 1:201 W BURNSVILLE PKWY
Mailing Address - Street 2:158
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2527
Mailing Address - Country:US
Mailing Address - Phone:952-224-9466
Mailing Address - Fax:
Practice Address - Street 1:201 W BURNSVILLE PKWY
Practice Address - Street 2:158
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2527
Practice Address - Country:US
Practice Address - Phone:952-224-9466
Practice Address - Fax:952-224-9466
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4325111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN690923000OtherMN-ITS PROVIDER NUMBER
MN350002995Medicare ID - Type UnspecifiedPROVIDER NUMBER
MNU97505Medicare UPIN