Provider Demographics
NPI:1114615150
Name:DOMIER CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:DOMIER CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DOMIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-207-8727
Mailing Address - Street 1:16180 HASTINGS AVE SE STE 202
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-9228
Mailing Address - Country:US
Mailing Address - Phone:952-991-1353
Mailing Address - Fax:
Practice Address - Street 1:16180 HASTINGS AVE SE STE 202
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-9228
Practice Address - Country:US
Practice Address - Phone:952-991-1353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty