Provider Demographics
NPI:1003170028
Name:DORIS, DIMITRIOS VASILIOS (DC)
Entity Type:Individual
Prefix:DR
First Name:DIMITRIOS
Middle Name:VASILIOS
Last Name:DORIS
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 1:10 POND ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1606
Mailing Address - Country:US
Mailing Address - Phone:973-553-1330
Mailing Address - Fax:973-341-9838
Practice Address - Street 1:23A CHURCH ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1331
Practice Address - Country:US
Practice Address - Phone:973-553-1330
Practice Address - Fax:973-341-9838
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00701300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor