Provider Demographics
NPI:1780684878
Name:DONOFRIO, DAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:DONOFRIO
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 162
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-0162
Mailing Address - Country:US
Mailing Address - Phone:732-859-2565
Mailing Address - Fax:
Practice Address - Street 1:245 ORADELL AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4808
Practice Address - Country:US
Practice Address - Phone:732-859-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00502600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2128946000OtherAMERIHEALTH HMO
NJ144531OtherAMERIHEALTH PPO
NJ8894604Medicaid
NJ144531OtherAMERIHEALTH PPO
NJU91152Medicare UPIN