Provider Demographics
NPI:1346645348
Name:BOMBERG, TOM (DC)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:
Last Name:BOMBERG
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 1:3410 WINNETKA AVE N STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2091
Mailing Address - Country:US
Mailing Address - Phone:763-450-1755
Mailing Address - Fax:763-496-1657
Practice Address - Street 1:3410 WINNETKA AVE N STE 100
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-2091
Practice Address - Country:US
Practice Address - Phone:763-450-1755
Practice Address - Fax:763-496-1657
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002780A111N00000X
IL038.012670111N00000X
MN6170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor