Provider Demographics
NPI:1164808481
Name:DIDOMENICO, JOHN Z (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:Z
Last Name:DIDOMENICO
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:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-0053
Mailing Address - Country:US
Mailing Address - Phone:732-539-0114
Mailing Address - Fax:732-738-4040
Practice Address - Street 1:515 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-2131
Practice Address - Country:US
Practice Address - Phone:732-738-0030
Practice Address - Fax:732-738-4040
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00729000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor