Provider Demographics
NPI:1043476195
Name:AUGUST J. DOMENICO JR. DC
Entity Type:Organization
Organization Name:AUGUST J. DOMENICO JR. DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUST
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOMENICO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-433-1322
Mailing Address - Street 1:12 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-2914
Mailing Address - Country:US
Mailing Address - Phone:716-433-1322
Mailing Address - Fax:716-433-0322
Practice Address - Street 1:3117 MILITARY RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-4813
Practice Address - Country:US
Practice Address - Phone:716-433-1322
Practice Address - Fax:716-433-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11989AMedicare PIN
NYW52002Medicare UPIN