Russo, Dominic A
Russo, Dominic A is an individual health care provider with primary practice located at 1265 Boardman Canfield Rd , Boardman OH 44512-4004. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. Russo, Dominic A can be contacted via phone (330) 758-9400.Contact Information
Primary practice address
1265 Boardman Canfield Rd
Boardman OH 44512-4004
Phone: (330) 758-9400
Fax: (330) 726-8676
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | 2330 | Ohio |
Profile Details
| NPI number | 1548269996 |
|---|---|
| LBN Legal business name | Russo, Dominic A |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 19th, 2005 |
| Last updated | May 17th, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548269996 | NPPES |
| Ohio | MEDICAID | 0460246 |
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