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General NPI Number Information
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NPI Number | 1144512195
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Entity Type | Organization
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Legal Business Name | DOMM FAMILY CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 9570 TRANSIT RD
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City | EAST AMHERST
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State | NY
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Zip | 14051-1403
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Country | US
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Telephone | 716-810-6075
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Fax |
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Provider Business Mailing Address
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Address Line | 39 COTTONWOOD DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-2316
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Country | US
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Telephone | 716-982-8232
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/PRESIDENT
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Name | DR. AMANDA DOMM
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Credential | D.C.
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Telephone | 716-982-8232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | X011961
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License Number State | NY
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