Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 991 | OH |
NPI | 1336285188 |
---|---|
Provider Name | Dr. Gary Cramer Domanick |
First Address | Richfield, OH 44286-9501 |
Second Address | Richfield, OH 44286-9501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DO 0542474 | (05) | OH |
T47975 | (02) | OH |