Provider Demographics
NPI:1912242264
Name:LEXINGTON SQUARE CHIROPRACTIC
Entity Type:Organization
Organization Name:LEXINGTON SQUARE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:FRISCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:763-784-5304
Mailing Address - Street 1:4137 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:CIRCLE PINES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-3529
Mailing Address - Country:US
Mailing Address - Phone:763-784-5304
Mailing Address - Fax:763-784-5349
Practice Address - Street 1:4137 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:CIRCLE PINES
Practice Address - State:MN
Practice Address - Zip Code:55014-3529
Practice Address - Country:US
Practice Address - Phone:763-784-5304
Practice Address - Fax:763-784-5349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty