Provider Demographics
NPI:1407138928
Name:SANDRA DOMAN DC LLC
Entity Type:Organization
Organization Name:SANDRA DOMAN DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:DOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-580-9588
Mailing Address - Street 1:18205 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 2217
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2106
Mailing Address - Country:US
Mailing Address - Phone:305-932-2218
Mailing Address - Fax:305-438-7977
Practice Address - Street 1:18205 BISCAYNE BLVD
Practice Address - Street 2:SUITE 2217
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-2106
Practice Address - Country:US
Practice Address - Phone:305-932-2218
Practice Address - Fax:305-438-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty