Provider Demographics
NPI:1790824852
Name:DASILVA, JOHN VIEIRA (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VIEIRA
Last Name:DASILVA
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 1:17 BRANT AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066
Mailing Address - Country:US
Mailing Address - Phone:732-815-1711
Mailing Address - Fax:973-465-3701
Practice Address - Street 1:17 BRANT AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066
Practice Address - Country:US
Practice Address - Phone:732-815-1711
Practice Address - Fax:973-465-3701
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00370000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U17498Medicare UPIN
DA671242Medicare ID - Type Unspecified