Robert J Didomenico, DC
Individual provider Active NPI Chiropractor · Minerva, OH
NPI 1215069737 · NPPES record last updated Nov 1, 2021
Key facts
- NPI
- 1215069737
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2095 (OH)
- Practice address
- 1164 Alliance Rd NW
Minerva, OH 44657-8736 - Phone
- (330) 868-2117
- Fax
- (866) 871-1668
- NPI assigned
- Mar 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- National College of Chiropractic, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1164 Alliance Rd NW
Minerva, OH 44657-8736
Phone (330) 868-2117
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120619000032 | OH | Practitioner - Chiropractic | 1254595556 | Practice locations: Minerva, OH |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2095 | OH | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2095 | OH | Yes |
Addresses
Primary practice location
1164 Alliance Rd NW
Minerva, OH 44657-8736
Mailing address
1164 Alliance Rd NW
Minerva, OH 44657-8736
Phone (330) 868-2117
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0991379 | Medicaid | OH |
Other providers in Minerva, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.