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General NPI Number Information
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NPI Number | 1548547706
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Entity Type | Organization
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Legal Business Name | ROBERT J. DIDOMENICO, D.C., P.C.
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 711 W. NORTH AVE 201
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City | CHICAGO
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State | IL
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Zip | 60610-1042
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Country | US
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Telephone | 312-664-9060
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Fax | 312-664-9181
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Provider Business Mailing Address
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Address Line | 711 W. NORTH AVENUE 201
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City | CHICAGO
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State | IL
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Zip | 60610-1042
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Country | US
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Telephone | 312-664-9060
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. ROBERT J DIDOMENICO
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Credential | D.C.
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Telephone | 312-664-9060
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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 | 038006616
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License Number State | IL
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