Active NPI
SDS Group PA
- Chiropractor
- St Louis Park, MN
National Provider Identifier
1285812412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 4370
- Legal business name
- SDS GROUP PA
- Doing business as
- Chiropractors of St. Anthony / Northeast
- Practice address
- 4833 Minnetonka Blvd
St Louis Park, MN 55416-2214 - NPI assigned
- Feb 11, 2008
- Organization subpart
- Yes
- Parent organization
- SDS GROUP PA
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Scott David Salita, DC
- Title
- President
- Phone
- (612) 991-3139
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 4370 | MN | Primary |
Addresses
Primary practice location
4833 Minnetonka Blvd
St Louis Park, MN 55416-2214
Mailing address
3813 Plymouth Rd
Minnetonka, MN 55305-5001
Phone (612) 991-3139
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 787250000 | Medicaid | MN | |
| 1065328 | Other | MN | BCBS CLINIC ID |
| 119H8CH | Other | MN | BCBS MN ID# |
Other names 1
- Chiropractors of St. Anthony / Northeast
National Provider Directory
National Provider Directory- Part of
- SDS Group PA
Locations
3433 Broadway St NE
Ste 187
Minneapolis, MN 55413
Phone (612) 781-1725
2931 Pentagon Dr
St Anthony, MN 55418
Phone (612) 781-1725
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202688000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1695859200000",
"number": "1285812412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3813 PLYMOUTH RD",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553055001",
"telephone_number": "612-991-3139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4833 MINNETONKA BLVD",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554162214"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SDS GROUP PA",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SDS GROUP PA",
"enumeration_date": "2008-02-11",
"last_updated": "2023-09-28",
"certification_date": "2023-09-28",
"status": "A",
"authorized_official_last_name": "SALITA",
"authorized_official_first_name": "SCOTT",
"authorized_official_middle_name": "DAVID",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "612-991-3139",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DC"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Chiropractor",
"state": "MN",
"license": "4370",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "787250000",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS CLINIC ID",
"identifier": "1065328",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MN ID#",
"identifier": "119H8CH",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Chiropractors of St. Anthony / Northeast",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.