Provider Demographics
NPI:1972896579
Name:OWEN, THOMAS J (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:OWEN
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 1:911 GOLDEN PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-2176
Mailing Address - Country:US
Mailing Address - Phone:605-842-3497
Mailing Address - Fax:605-842-4476
Practice Address - Street 1:911 GOLDEN PRAIRIE DR
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2176
Practice Address - Country:US
Practice Address - Phone:605-842-3497
Practice Address - Fax:605-842-4476
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor