Provider Demographics
NPI:1508171497
Name:CEDAR SOUTH CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:CEDAR SOUTH CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:AZA
Authorized Official - Last Name:SENECAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-432-5550
Mailing Address - Street 1:14135 CEDAR AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4522
Mailing Address - Country:US
Mailing Address - Phone:952-432-5550
Mailing Address - Fax:952-432-0057
Practice Address - Street 1:14135 CEDAR AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4522
Practice Address - Country:US
Practice Address - Phone:952-432-5550
Practice Address - Fax:952-432-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002498Medicare PIN