Individual provider Active NPI

Zen Matsuda, D.C.

  • Chiropractor
  • Eden Prairie, MN
National Provider Identifier
1356672075
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5320 Issued in MN
Practice address
6400 Flying Cloud Dr Ste 213
Eden Prairie, MN 55344-3331
Phone
(952) 500-8733
Fax
(763) 592-8142
NPI assigned
Jan 20, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5320 MN Primary

Addresses

Primary practice location

6400 Flying Cloud Dr Ste 213
Eden Prairie, MN 55344-3331

Mailing address

4570 West 77TH Street
Suite 140
Edina, MN 55435-7015
Phone (952) 500-8733

Other identifiers 1

IdentifierTypeStateIssuer
1356672075MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100423000644 MN Practitioner - Chiropractic 3971630823 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2008
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4570 W 77TH St
Suite 140
Edina, MN 55435-5004
Phone (952) 500-8733

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5320MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Zen Chiropractic Incoporated Chiropractor CurrentSince May 1, 2011 Accepting new patients
Zen Chiropractic Inc Current Accepting new patients
Innate & Hyack Family Chiropractic LLC Chiropractor PastSince Oct 21, 2005 Accepting new patients

Locations

6400 Flying Cloud Dr
Ste 213
Eden Prairie, MN 55344
Phone (612) 564-8101

4570 77th St W
Ste 140
Minneapolis, MN 55435
Phone (612) 886-7763

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1356672075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4570 WEST 77TH STREET",
            "address_2": "SUITE 140",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554357015",
            "telephone_number": "952-500-8733",
            "fax_number": "763-592-8142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 FLYING CLOUD DR STE 213",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443331",
            "telephone_number": "952-500-8733",
            "fax_number": "763-592-8142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATSUDA",
        "first_name": "ZEN",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-20",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356672075",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.