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
Fax: (330) 726-8676
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548269996 NPPES
Ohio MEDICAID 0460246

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