Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1129 | OH |
NPI | 1508865817 |
---|---|
Provider Name | Dr. Joseph A Didomenico |
First Address | Boardman, OH 44512-4004 |
Second Address | Boardman, OH 44512-4004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 18/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0154676 | (05) | OH |
T48258 | (02) | OH |