Provider Demographics
NPI:1306824099
Name:TOMAINO, MARIO J (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:J
Last Name:TOMAINO
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 1:2323 NW FLANDERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3409
Mailing Address - Country:US
Mailing Address - Phone:503-223-3826
Mailing Address - Fax:503-223-0742
Practice Address - Street 1:2323 NW FLANDERS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3409
Practice Address - Country:US
Practice Address - Phone:503-223-3826
Practice Address - Fax:503-223-0742
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WBBBMedicare PIN