Provider Demographics
NPI:1346460383
Name:SUSAN DOMINIK
Entity Type:Organization
Organization Name:SUSAN DOMINIK
Other - Org Name:FIVE POINTS CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-945-1100
Mailing Address - Street 1:1609 WOODBOURNE RD
Mailing Address - Street 2:SUITE 401A
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1500
Mailing Address - Country:US
Mailing Address - Phone:215-945-1100
Mailing Address - Fax:215-945-5086
Practice Address - Street 1:1609 WOODBOURNE RD
Practice Address - Street 2:SUITE 401A
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1500
Practice Address - Country:US
Practice Address - Phone:215-945-1100
Practice Address - Fax:215-945-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003470L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011499230004Medicaid
PADO545798Medicare ID - Type Unspecified