Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC27596 | CA |
N | 111NS0005X | Chiropractic Sports Physician | DC27596 | CA |
N | 111NX0100X | Occupational Health | DC27596 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | DC27596 | CA |
NPI | 1760587364 |
---|---|
Provider Name | Dr. Domenic Didomenicantonio |
First Address | Torrance, CA 90505-6658 |
Second Address | Torrance, CA 90505-6658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 09/09/2008 |