MEDICARE: DR. JEROME CYRIL DOMBECK DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2926	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000137177	OTHER	OH	ANTHE BC BS
2	8465070	OTHER	OH	AETNA
3	03846	OTHER	OH	PARAMOUNT

General Provider Information

NPI Number	:	1366583973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME CYRIL DOMBECK DC

Provider Business Mailing Address
First Line	:	4157 SYLVANIA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623
Country	:	US
Telephone Number	:	419-475-8326
Fax Number	:	419-475-8256

Provider Business Practice Location Address
First Line	:	4157 SYLVANIA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623
Country	:	US
Telephone Number	:	419-475-8326
Fax Number	:	419-475-8256

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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