Healthcare Provider Details

I. General information

NPI: 1376527903
Provider Name (Legal Business Name): JASON E. DOMER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/08/2007
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 NumberDC008005L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: