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General NPI Number Information
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NPI Number | 1043476195
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Entity Type | Organization
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Legal Business Name | AUGUST J. DOMENICO JR. DC
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 3117 MILITARY RD
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City | NIAGARA FALLS
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State | NY
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Zip | 14304-4813
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Country | US
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Telephone | 716-433-1322
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Fax | 716-433-0322
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Provider Business Mailing Address
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Address Line | 12 MARKET ST
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City | LOCKPORT
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State | NY
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Zip | 14094-2914
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Country | US
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Telephone | 716-433-1322
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Fax | 716-433-0322
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Authorized Official
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Title or Position | OWNER
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Name | DR. AUGUST J DOMENICO
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Credential | DC
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Telephone | 716-433-1322
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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 | X3416
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License Number State | NY
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