Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00701300 | NJ |
NPI | 1003170028 |
---|---|
Provider Name | Dr. Dimitrios Vasilios Doris |
First Address | Clifton, NJ 07013-1606 |
Second Address | Paterson, NJ 07505-1331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2012 |
Last Update Date | 20/06/2014 |