Provider Demographics
NPI:1013389394
Name:DOMAGALSKI, JULIANN (LAC)
Entity Type:Individual
Prefix:
First Name:JULIANN
Middle Name:
Last Name:DOMAGALSKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11608 DEAN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9654
Mailing Address - Country:US
Mailing Address - Phone:773-366-2692
Mailing Address - Fax:
Practice Address - Street 1:11608 DEAN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9654
Practice Address - Country:US
Practice Address - Phone:773-366-2692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000837171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist