Provider Demographics
NPI:1407882335
Name:DOMARACKI, LAWRENCE J
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:DOMARACKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 E WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2310
Mailing Address - Country:US
Mailing Address - Phone:562-424-4976
Mailing Address - Fax:562-424-5960
Practice Address - Street 1:3311 E WILLOW STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-424-4976
Practice Address - Fax:562-424-5960
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 20570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor