Organization
DOMENICK PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAYNE E DOMENICK DC (DOCTOR OWNER)
(810) 744-4251
Entity
Organization
Contact information
Practice address
4085 S CENTER RD, BURTON, MI 48519-1957
(810) 744-4251
(810) 744-1039
Mailing address
4085 S CENTER RD, BURTON, MI 48519-1957
(810) 744-4251
(810) 744-1039
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301008818
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
950B514920
BCBSM
MI
01
—
950B518000
BCBSM
MI
Enumeration date
02/07/2007
Last updated
08/07/2008
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