Provider Demographics
NPI:1346253572
Name:DOMBROSKI-SPEAKS, VERONICA LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:LEE
Last Name:DOMBROSKI-SPEAKS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62675-9778
Mailing Address - Country:US
Mailing Address - Phone:217-632-7856
Mailing Address - Fax:217-632-4345
Practice Address - Street 1:13936 STATE HIGHWAY 97
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IL
Practice Address - Zip Code:62675-6018
Practice Address - Country:US
Practice Address - Phone:217-632-4455
Practice Address - Fax:217-632-4345
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU51260Medicare UPIN
IL205257Medicare ID - Type Unspecified