MEDICARE: EXCEPTIONAL CHIROPRACTIC P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4695	MN

General Provider Information

NPI Number	:	1881795961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEPTIONAL CHIROPRACTIC P A

Provider Business Mailing Address
First Line	:	2415 149TH AVE NE
Second Line	:
City	:	HAM LAKE
State	:	MN
Zip	:	55304-6323
Country	:	US
Telephone Number	:	612-418-3587
Fax Number	:	763-208-2911

Provider Business Practice Location Address
First Line	:	16230 ABERDEEN ST NE STE B
Second Line	:
City	:	HAM LAKE
State	:	MN
Zip	:	55304-5432
Country	:	US
Telephone Number	:	763-208-5382
Fax Number	:	763-208-2911

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTINE A H INGBRETSON
Credential	:	D.C.
Telephone Number	:	612-418-3587

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	03/01/2024

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