Provider Demographics
NPI:1831676931
Name:DOMINGO, KERRI (DC)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:DOMINGO
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 1:8160 MIRA MESA BLVD STE 141
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2602
Mailing Address - Country:US
Mailing Address - Phone:619-273-3712
Mailing Address - Fax:619-374-7439
Practice Address - Street 1:8160 MIRA MESA BLVD STE 141
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2602
Practice Address - Country:US
Practice Address - Phone:619-273-3712
Practice Address - Fax:619-374-7439
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34500111N00000X
SC4361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor