Provider Demographics
NPI:1063587293
Name:DASILVA, DENNIS JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JOHN
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 1:1025 SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4503
Mailing Address - Country:US
Mailing Address - Phone:631-434-7053
Mailing Address - Fax:631-951-2715
Practice Address - Street 1:1025 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4503
Practice Address - Country:US
Practice Address - Phone:631-434-7053
Practice Address - Fax:631-951-2715
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX04915-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT52964Medicare UPIN
NYX27111Medicare ID - Type UnspecifiedMEDICARE NUMBER