Shane Alex Boroditsky, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3976 Issued in MN

Practice address

12000 Elm Creek Blvd N
Suite L70
Maple Grove, MN 55369-7073

Phone

(612) 281-3575

Fax

(612) 605-8257

NPI assigned

Aug 20, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

National College of Chiropractic, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shane a. Boroditsky, P.a.

  • Chiropractor
  • Maple Grove, MN
  • NPI 1043313828
  Medicare reassignment NPD Authorized official
• Cich Chiropractic

  • Chiropractor
  • Maple Grove, MN
  • NPI 1225198856
  NPD (past)
• Okeefe Chiropractic Clinic Inc.

  • Chiropractor
  • Saint Paul, MN
  • NPI 1043434616
  NPD (past)
• Trillium Chiropractic, P.a.

  • Chiropractor
  • Maple Grove, MN
  • NPI 1467682732
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962517870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 582774",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554582774",
            "telephone_number": "612-281-3575",
            "fax_number": "612-605-8257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 ELM CREEK BLVD N",
            "address_2": "SUITE L70",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697073",
            "telephone_number": "612-281-3575",
            "fax_number": "612-605-8257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORODITSKY",
        "first_name": "SHANE",
        "middle_name": "ALEX",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "110238",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS / BLUE SHIELD",
            "identifier": "329G7BO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "44-50913",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis A. Bolick, PA-C
• Michele Bolte, LMT
• Megan R Bonniwell, DPT
• Anneka Marie Boomsma, DPT
• Lynn Renee Borgmann, MA, LADC, LPC
• Joettle Borward
• Julie Bosacker
• Boulder Point Access LLC
• Christine Elizabeth Boumann, PA-C
• Madison Diane Boutwell

• All providers in Maple Grove, MN
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.