Healthcare Provider Details

I. General information

NPI: 1861557217
Provider Name (Legal Business Name): INGBRETSON CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 LEXINGTON AVE N
ROSEVILLE MN
55113-6516
US

IV. Provider business mailing address

8942 WOODHALL CIR
BROOKLYN PARK MN
55443-1637
US

V. Phone/Fax

Practice location:
  • Phone: 651-487-5950
  • Fax: 651-487-6016
Mailing address:
  • Phone: 763-493-0487
  • Fax: 763-493-0487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4722
License Number StateMN

VIII. Authorized Official

Name: DR. HEATHER ELISE INGBRETSON
Title or Position: CEO
Credential: D.C.
Phone: 763-226-1129