S Group PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

S GROUP PC

Doing business as

Dr. Ethan Skog

Practice address

4900 Highway 169 N Ste 301
New Hope, MN 55428-4019

Phone

(763) 496-7871

NPI assigned

Aug 21, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Ethan Lee Skog, DC

Title

Chiropractor

Phone

(763) 496-7871

Specialties & licenses 1

Addresses

Other names 1

• Dr. Ethan Skog Doing business as

Locations

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

{
    "created_epoch": "1566345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579478400000",
    "number": "1447807813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 HIGHWAY 169 N STE 301",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554284019",
            "telephone_number": "763-496-7871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 HIGHWAY 169 N STE 301",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554284019",
            "telephone_number": "763-496-7871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-21",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A",
        "authorized_official_last_name": "SKOG",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "763-496-7871",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Ethan Skog",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dr. Ethan Skog",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mahamed Salah
• Mark Tyler Schiffmann, PHARMD

• Chiropractor in New Hope, MN
• Providers in New Hope, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.