Provider Demographics
NPI:1144512195
Name:DOMM FAMILY CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:DOMM FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-982-8232
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 1:9570 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1403
Practice Address - Country:US
Practice Address - Phone:716-810-6075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011961261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center