Provider Demographics
NPI:1881916146
Name:KOMRO, MICHAEL PHILIP (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PHILIP
Last Name:KOMRO
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 1:5100 THIMSEN AVE STE 200
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4160
Mailing Address - Country:US
Mailing Address - Phone:612-564-5051
Mailing Address - Fax:715-875-4901
Practice Address - Street 1:5100 THIMSEN AVE STE 200
Practice Address - Street 2:SUITE 200
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4160
Practice Address - Country:US
Practice Address - Phone:612-564-5051
Practice Address - Fax:715-875-4901
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4594-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor