Provider Demographics
NPI:1225009863
Name:DOMBROSKI, STANLEY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:ALLEN
Last Name:DOMBROSKI
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 1:300 S STATE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1676
Mailing Address - Country:US
Mailing Address - Phone:616-772-9255
Mailing Address - Fax:616-772-9258
Practice Address - Street 1:300 S STATE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1676
Practice Address - Country:US
Practice Address - Phone:616-772-9255
Practice Address - Fax:616-772-9258
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISD008737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950G010840OtherBLUE CROSS BLUE SHIELD MI
MI950G010840OtherBLUE CROSS BLUE SHIELD MI
MIN83030001Medicare ID - Type Unspecified