Provider Demographics
NPI:1699764779
Name:OMENSKI, JOHN (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:OMENSKI
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 1:7533 MEMORIAL PKWY SW
Mailing Address - Street 2:STE B
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2257
Mailing Address - Country:US
Mailing Address - Phone:256-880-6199
Mailing Address - Fax:256-880-3736
Practice Address - Street 1:7533 MEMORIAL PKWY SW
Practice Address - Street 2:STE B
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2257
Practice Address - Country:US
Practice Address - Phone:256-880-6199
Practice Address - Fax:256-880-3736
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL1435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51077383OtherBCBS
AL000077383OMEMedicare PIN
AL51077383OtherBCBS