Provider Demographics
NPI:1154796761
Name:OOMMEN, PHILIP JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOHN
Last Name:OOMMEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10705 TOWN SQUARE DR NE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-8184
Mailing Address - Country:US
Mailing Address - Phone:763-600-6134
Mailing Address - Fax:763-600-6131
Practice Address - Street 1:10705 TOWN SQUARE DR NE
Practice Address - Street 2:SUITE 220
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-8184
Practice Address - Country:US
Practice Address - Phone:763-600-6134
Practice Address - Fax:763-600-6131
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor