Provider Demographics
NPI:1215069737
Name:DIDOMENICO, ROBERT J (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:DIDOMENICO
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 1:1164 ALLIANCE RD NW
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-8736
Mailing Address - Country:US
Mailing Address - Phone:330-868-2117
Mailing Address - Fax:866-871-1668
Practice Address - Street 1:1164 ALLIANCE RD NW
Practice Address - Street 2:
Practice Address - City:MINERVA
Practice Address - State:OH
Practice Address - Zip Code:44657-8736
Practice Address - Country:US
Practice Address - Phone:330-868-2117
Practice Address - Fax:866-871-1668
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0991379Medicaid
OHU05235Medicare UPIN
OH0991379Medicaid