Healthcare Provider Details

I. General information

NPI: 1689156358
Provider Name (Legal Business Name): EXPONENTIAL CHIROPRACTIC HEALING CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 COLLEGE AVE N
SAINT JOSEPH MN
56374-9801
US

IV. Provider business mailing address

103 COLLEGE AVE N
SAINT JOSEPH MN
56374-0018
US

V. Phone/Fax

Practice location:
  • Phone: 320-363-4573
  • Fax: 320-363-1314
Mailing address:
  • Phone: 320-363-4573
  • Fax: 320-363-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1386
License Number StateMN

VIII. Authorized Official

Name: DR. BRIAN S KOLTES
Title or Position: OWNER
Credential:
Phone: 320-363-4573