Provider Demographics
NPI:1699849810
Name:SMORRA, DOMINIC (DC)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:
Last Name:SMORRA
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 1:18 WARD PL
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5008
Mailing Address - Country:US
Mailing Address - Phone:973-226-3321
Mailing Address - Fax:973-226-6654
Practice Address - Street 1:18 WARD PL
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5008
Practice Address - Country:US
Practice Address - Phone:973-226-3321
Practice Address - Fax:973-226-6654
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
631125Medicare PIN