Healthcare Provider Details

I. General information

NPI: 1487847992
Provider Name (Legal Business Name): CAN-AM RADIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 SW FUGE RD
STUART FL
34997-6269
US

IV. Provider business mailing address

472 SW FUGE RD
STUART FL
34997-6269
US

V. Phone/Fax

Practice location:
  • Phone: 772-781-2651
  • Fax:
Mailing address:
  • Phone: 772-781-2651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberCH8308
License Number StateFL

VIII. Authorized Official

Name: DR. NORBERT DOMBROWSKY
Title or Position: PRESIDENT
Credential: DACBR
Phone: 561-624-6170