Healthcare Provider Details

I. General information

NPI: 1033526538
Provider Name (Legal Business Name): ELEVATED HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10705 TOWN SQUARE DR NE STE 220
BLAINE MN
55449-8184
US

IV. Provider business mailing address

10705 TOWN SQUARE DR NE STE 220
BLAINE MN
55449-8184
US

V. Phone/Fax

Practice location:
  • Phone: 651-216-1997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5551
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number5551
License Number StateMN

VIII. Authorized Official

Name: DR. DAVID OOMMEN
Title or Position: DOCTOR/OWNER
Credential: D.C.
Phone: 651-216-1997