Healthcare Provider Details

I. General information

NPI: 1275517807
Provider Name (Legal Business Name): DOMER CHIROPRACTIC WELLNESS CENTER PC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 ALLEGHENY RIVER BLVD
OAKMONT PA
15139-1725
US

IV. Provider business mailing address

426 ALLEGHENY RIVER BLVD
OAKMONT PA
15139-1725
US

V. Phone/Fax

Practice location:
  • Phone: 412-828-4383
  • Fax:
Mailing address:
  • Phone: 412-828-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC008006L
License Number StatePA

VIII. Authorized Official

Name: DR. ZACKARY W JENNICHES
Title or Position: OWNER
Credential: D.C.
Phone: 412-828-4383