MEDICARE: DR. VINCENT DOMINGO DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038-010182	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	668809	OTHER	IL	UNITED HEALTHCARE
2	20-2769660	OTHER	IL	CHOICE CARE/HUMANA
3	7296704	OTHER	IL	AETNA
4	9386175	OTHER	IL	PRIVATE HEALTCARE SYSTEMS

General Provider Information

NPI Number	:	1033198643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT DOMINGO DC

Provider Business Mailing Address
First Line	:	4149 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4314
Country	:	US
Telephone Number	:	847-671-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	4149 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4314
Country	:	US
Telephone Number	:	725-421-1117
Fax Number	:	773-542-7100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/13/2020

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Directions to “ DR. VINCENT DOMINGO DC” Practice Location

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