NPIMap

Individual provider Active NPI

Michael Philip Komro, D.C.

  • Chiropractor
  • Minnetonka, MN
National Provider Identifier
1881916146
Registry record updated Dec 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4594-012 Issued in WI
Practice address
5100 Thimsen Ave Ste 200
Suite 200
Minnetonka, MN 55345-4160
Phone
(612) 564-5051
Fax
(715) 875-4901
NPI assigned
Feb 26, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4594-012 WI Primary

Addresses

Primary practice location

5100 Thimsen Ave Ste 200
Suite 200
Minnetonka, MN 55345-4160

Mailing address

5100 Thimsen Ave Ste 200
Suite 200
Minnetonka, MN 55345-4160
Phone (612) 564-5051

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4594-012WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Health Steps, L.L.C. Chiropractor Past Accepting new patients
Affinity Chiropractic LLCQ Chiropractor Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1267142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293062400000",
    "number": "1881916146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 THIMSEN AVE STE 200",
            "address_2": "SUITE 200",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454160",
            "telephone_number": "612-564-5051",
            "fax_number": "715-875-4901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 THIMSEN AVE STE 200",
            "address_2": "SUITE 200",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454160",
            "telephone_number": "612-564-5051",
            "fax_number": "715-875-4901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMRO",
        "first_name": "MICHAEL",
        "middle_name": "PHILIP",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-26",
        "last_updated": "2010-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4594-012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.