Provider Demographics
NPI:1982936357
Name:DOMM, AMANDA ERIN (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ERIN
Last Name:DOMM
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 1:39 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2316
Mailing Address - Country:US
Mailing Address - Phone:716-982-8232
Mailing Address - Fax:
Practice Address - Street 1:5854 SNYDER DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9497
Practice Address - Country:US
Practice Address - Phone:716-434-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor