Provider Demographics
NPI:1932691714
Name:EXCELSIOR AND GRAND CHIROPRACTIC
Entity Type:Organization
Organization Name:EXCELSIOR AND GRAND CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLATGARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-920-9247
Mailing Address - Street 1:7500 HIGHWAY 7 APT 452
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5605 W 36TH ST STE 100C
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2599
Practice Address - Country:US
Practice Address - Phone:952-920-9247
Practice Address - Fax:952-922-3480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty