Provider Demographics
NPI:1689156358
Name:EXPONENTIAL CHIROPRACTIC HEALING CENTER PLLC
Entity Type:Organization
Organization Name:EXPONENTIAL CHIROPRACTIC HEALING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLTES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-363-4573
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374-0237
Mailing Address - Country:US
Mailing Address - Phone:320-363-4573
Mailing Address - Fax:320-363-1314
Practice Address - Street 1:103 COLLEGE AVE N
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MN
Practice Address - Zip Code:56374-9801
Practice Address - Country:US
Practice Address - Phone:320-363-4573
Practice Address - Fax:320-363-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN818825400Medicaid