Provider Demographics
NPI:1225038847
Name:TOMINELLO, DANIEL VICTOR (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:VICTOR
Last Name:TOMINELLO
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 1:1632 MILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1040
Mailing Address - Country:US
Mailing Address - Phone:248-548-3333
Mailing Address - Fax:
Practice Address - Street 1:1632 MILLARD AVE
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1040
Practice Address - Country:US
Practice Address - Phone:248-765-2587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OF354500OtherBLUE CROSS
MIU56999Medicare UPIN
MION85760Medicare ID - Type UnspecifiedPROVIDER ID