Provider Demographics
NPI:1194365346
Name:DOMINGUEZ, KENNETH (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:DOMINGUEZ
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 1:4747 RESEARCH FOREST DR STE 195
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4909
Mailing Address - Country:US
Mailing Address - Phone:346-831-0670
Mailing Address - Fax:346-831-0685
Practice Address - Street 1:4747 RESEARCH FOREST DR STE 195
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-4909
Practice Address - Country:US
Practice Address - Phone:346-831-0670
Practice Address - Fax:346-831-0685
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor