Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC008006L | PA |
NPI | 1003890633 |
---|---|
Provider Name | Melinda M. Domer |
First Address | Oakmont, PA 15139-1725 |
Second Address | Oakmont, PA 15139-1725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U92825 | (02) | PA |