Provider Demographics
NPI:1881795961
Name:EXCEPTIONAL CHIROPRACTIC P A
Entity type:Organization
Organization Name:EXCEPTIONAL CHIROPRACTIC P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A H
Authorized Official - Last Name:INGBRETSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-418-3587
Mailing Address - Street 1:2415 149TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-6323
Mailing Address - Country:US
Mailing Address - Phone:612-418-3587
Mailing Address - Fax:763-208-2911
Practice Address - Street 1:16230 ABERDEEN ST NE STE B
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-5432
Practice Address - Country:US
Practice Address - Phone:763-208-5382
Practice Address - Fax:763-208-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV06218Medicare UPIN
MNC04036Medicare PIN