Provider Demographics
NPI:1639528508
Name:ACTIVE MOBILITY PRACTITIONER PA
Entity Type:Organization
Organization Name:ACTIVE MOBILITY PRACTITIONER PA
Other - Org Name:CHANHASSEN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SACHDEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-934-4500
Mailing Address - Street 1:7800 MARKET BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9440
Mailing Address - Country:US
Mailing Address - Phone:952-934-4500
Mailing Address - Fax:651-412-5063
Practice Address - Street 1:7800 MARKET BLVD
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9440
Practice Address - Country:US
Practice Address - Phone:952-934-4500
Practice Address - Fax:651-412-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
MN5961111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1639528508OtherPRACTICE NPI