MEDICARE: ACTIVE MOBILITY PRACTITIONER 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
1	111NS0005X	Sports Physician Chiropractor	5961	MN
2	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1639528508	OTHER	MN	PRACTICE NPI

General Provider Information

NPI Number	:	1639528508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE MOBILITY PRACTITIONER PA

Provider Business Mailing Address
First Line	:	7800 MARKET BLVD
Second Line	:
City	:	CHANHASSEN
State	:	MN
Zip	:	55317-9440
Country	:	US
Telephone Number	:	952-934-4500
Fax Number	:	651-412-5063

Provider Business Practice Location Address
First Line	:	7800 MARKET BLVD
Second Line	:
City	:	CHANHASSEN
State	:	MN
Zip	:	55317-9440
Country	:	US
Telephone Number	:	952-934-4500
Fax Number	:	651-412-5063

Authorized Official
Title or Position	:	CEO/ CHIROPRACTOR
Name	:	DR. ROHIN SACHDEVA
Credential	:	DC
Telephone Number	:	952-934-4500

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	10/26/2023

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Directions to “ACTIVE MOBILITY PRACTITIONER PA ” Practice Location

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