Provider Demographics
NPI:1568846145
Name:SILVA, WANDERSON M (DC)
Entity Type:Individual
Prefix:
First Name:WANDERSON
Middle Name:M
Last Name:SILVA
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 1:613 HOPE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1279
Mailing Address - Country:US
Mailing Address - Phone:848-456-4782
Mailing Address - Fax:
Practice Address - Street 1:613 HOPE RD STE 1
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1279
Practice Address - Country:US
Practice Address - Phone:848-456-4782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00718500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor