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General NPI Number Information
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NPI Number | 1811590409
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Entity Type | Individual
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Provider Name | CHRISTOPHER ANTHONY DOMINIC DC
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Gender | Male
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 08/31/2025
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Provider Practice Location Address
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Address Line | 2305 SE WASHINGTON ST STE 105
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City | PORTLAND
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State | OR
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Zip | 97222-7647
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Country | US
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Telephone | 949-230-5737
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Fax |
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Provider Business Mailing Address
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Address Line | 2305 SE WASHINGTON ST STE 105
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City | PORTLAND
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State | OR
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Zip | 97222-7647
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Country | US
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Telephone | 949-230-5737
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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 | 6111
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License Number State | OR
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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 | 35157
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License Number State | CA
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