MEDICARE: EDMOND DOOMAN 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	DC22648	CA

General Provider Information

NPI Number	:	1689737447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMOND DOOMAN DC

Provider Business Mailing Address
First Line	:	4087 MISSION OAKS BLVD
Second Line	:	STE B
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5156
Country	:	US
Telephone Number	:	805-484-1077
Fax Number	:	805-484-1079

Provider Business Practice Location Address
First Line	:	4087 MISSION OAKS BLVD STE B
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5156
Country	:	US
Telephone Number	:	805-419-4234
Fax Number	:	805-484-1079

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	01/06/2021

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Directions to “ EDMOND DOOMAN DC” Practice Location

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