Provider Demographics
NPI:1194813402
Name:OMAN, KIM WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:WAYNE
Last Name:OMAN
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 1:1648 US HIGHWAY 130
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3016
Mailing Address - Country:US
Mailing Address - Phone:732-297-7070
Mailing Address - Fax:732-297-4433
Practice Address - Street 1:1648 US HIGHWAY 130
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3016
Practice Address - Country:US
Practice Address - Phone:732-297-7070
Practice Address - Fax:732-297-4433
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00145900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor