MEDICARE: SCHOLASTIC HEALTH GROUP

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	111NS0005X	Sports Physician Chiropractor	4943	MN

General Provider Information

NPI Number	:	1407303688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHOLASTIC HEALTH GROUP

Provider Business Mailing Address
First Line	:	8577 COLUMBINE RD
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344
Country	:	US
Telephone Number	:	952-479-0043
Fax Number	:	952-944-1673

Provider Business Practice Location Address
First Line	:	8577 COLUMBINE RD
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344
Country	:	US
Telephone Number	:	952-479-0043
Fax Number	:	952-944-1673

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HOLLY WESTBROCK
Credential	:	D.C.
Telephone Number	:	763-228-4461

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	09/06/2016

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