Provider Demographics
NPI:1427268044
Name:DORNINK, MARSHALL EUGENE (DC, ATC)
Entity type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:EUGENE
Last Name:DORNINK
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 AUTUMNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-2604
Mailing Address - Country:US
Mailing Address - Phone:701-212-0856
Mailing Address - Fax:
Practice Address - Street 1:1900 RIDGE RD
Practice Address - Street 2:SUITE 127
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3332
Practice Address - Country:US
Practice Address - Phone:716-677-2969
Practice Address - Fax:716-674-2969
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY67 0014792083S0010X
NY70012627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine