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General NPI Number Information
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NPI Number | 1649944422
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Entity Type | Organization
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Legal Business Name | DOMENICO PLLC
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 601 IL ROUTE 59
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City | INGLESIDE
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State | IL
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Zip | 60041-9342
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Country | US
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Telephone | 847-815-5972
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Fax |
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Provider Business Mailing Address
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Address Line | 601 IL ROUTE 59
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City | INGLESIDE
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State | IL
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Zip | 60041-9342
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANA DOMENICO MULIGANO
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Credential | DC
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Telephone | 847-815-5972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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