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Organization
VINCENT DOMINGO DC CSCS PROFESSIONAL CORPORATION
Active
Organization
VINCENT DOMINGO DC CSCS PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINCENT DOMINGO DC (OWNER/PRESIDENT)
(773) 472-0700
Entity
Organization
Contact information
Practice address
1255 W DIVERSEY PKWY, CHICAGO, IL 60614-1201
(773) 472-0700
Mailing address
1255 W DIVERSEY PKWY, CHICAGO, IL 60614-1111
(773) 472-0700
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-010182
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635354
BLUE CROSS BLUE SHIELD
IL
01
—
11487753
CAQH
IL
01
—
668809
UNITED HEALTHCARE
IL
01
—
7199662
CIGNA
IL
01
—
7296704
AETNA
IL
01
—
9386175
PHCS
IL
01
—
DE5467
RAILROAD MEDICARE GROUP
IL
01
—
P00299763
RAILROAD MEDICARE PIN
IL
Enumeration date
12/14/2009
Last updated
10/18/2013
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