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NPI Code Detail

MEDICARE: SDS GROUP PA

MEDICARE: SDS GROUP PA
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
1111N00000XChiropractor4370MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21065328OTHERMNBCBS CLINIC ID
3119H8CHOTHERMNBCBS MN ID#

General Provider Information

NPI Number : 1285812412
Entity Type Code : Organization
Provider Name (Legal Business Name) : SDS GROUP PA
Provider Business Mailing Address
First Line : 3813 PLYMOUTH RD
Second Line :
City : MINNETONKA
State : MN
Zip : 55305-5001
Country : US
Telephone Number : 612-991-3139
Fax Number :
Provider Business Practice Location Address
First Line : 4833 MINNETONKA BLVD
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-2214
Country : US
Telephone Number :
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. SCOTT DAVID SALITA
Credential : DC
Telephone Number : 612-991-3139
Provider Enumeration Date : 02/11/2008
Last Update Date : 09/28/2023

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Directions to “SDS GROUP PA ” Practice Location

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