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General NPI Number Information
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NPI Number | 1033198643
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Entity Type | Individual
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Provider Name | VINCENT DOMINGO DC
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Gender | Male
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 4149 W 26TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-4314
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Country | US
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Telephone | 725-421-1117
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Fax | 773-542-7100
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Provider Business Mailing Address
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Address Line | 4149 W 26TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-4314
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Country | US
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Telephone | 847-671-0555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038-010182
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License Number State | IL
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