Healthcare Provider Details

I. General information

NPI: 1902082100
Provider Name (Legal Business Name): VINCENT DOMINGO DC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 N ROSE STREET
FRANKLIN PARK IL
60131
US

IV. Provider business mailing address

3545 N ROSE STREET
FRANKLIN PARK IL
60131
US

V. Phone/Fax

Practice location:
  • Phone: 847-671-0555
  • Fax: 847-671-0685
Mailing address:
  • Phone: 847-671-0555
  • Fax: 847-671-0685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VINCENT DOMINGO
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 847-671-0555