Healthcare Provider Details

I. General information

NPI: 1639528508
Provider Name (Legal Business Name): ACTIVE MOBILITY PRACTITIONER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 MARKET BLVD
CHANHASSEN MN
55317-9440
US

IV. Provider business mailing address

7800 MARKET BLVD
CHANHASSEN MN
55317-9440
US

V. Phone/Fax

Practice location:
  • Phone: 952-934-4500
  • Fax: 651-412-5063
Mailing address:
  • Phone: 952-934-4500
  • Fax: 651-412-5063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5961
License Number StateMN

VIII. Authorized Official

Name: DR. ROHIN SACHDEVA
Title or Position: CEO/ CHIROPRACTOR
Credential: DC
Phone: 952-934-4500