Provider Demographics
NPI:1801839865
Name:DOMBY, GARY MICHEAL (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MICHEAL
Last Name:DOMBY
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:PO BOX 1108/52481 SW 1ST
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056
Mailing Address - Country:US
Mailing Address - Phone:503-543-3195
Mailing Address - Fax:
Practice Address - Street 1:52481 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-3531
Practice Address - Country:US
Practice Address - Phone:503-543-3195
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT67569Medicare UPIN
OR0000QGFBVMedicare ID - Type Unspecified