Provider Demographics
NPI:1033198643
Name:DOMINGO, VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:DOMINGO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4149 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4314
Mailing Address - Country:US
Mailing Address - Phone:847-671-0555
Mailing Address - Fax:
Practice Address - Street 1:4149 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4314
Practice Address - Country:US
Practice Address - Phone:725-421-1117
Practice Address - Fax:773-542-7100
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL668809OtherUNITED HEALTHCARE
IL20-2769660OtherCHOICE CARE/HUMANA
IL7296704OtherAETNA
IL9386175OtherPRIVATE HEALTCARE SYSTEMS
ILV05866Medicare UPIN
IL7296704OtherAETNA