Individual provider Active NPI

John Vieira Dasilva, DC

  • Chiropractor
  • Clark, NJ
National Provider Identifier
1790824852
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
38MC00370000 Issued in NJ
Practice address
17 Brant Ave
Suite #4
Clark, NJ 07066
Phone
(732) 815-1711
Fax
(973) 465-3701
NPI assigned
Feb 5, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 38MC00370000 NJ Primary

Addresses

Primary practice location

17 Brant Ave
Suite #4
Clark, NJ 07066

Mailing address

17 Brant Ave
Suite #4
Clark, NJ 07066
Phone (732) 815-1711

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120105000730 NJ Practitioner - Chiropractic 9436325875 Practice locations: Clark, NJ; Newark, NJ

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 1988
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

17 Brant Ave
Clark, NJ 07066-1548
Phone (732) 815-1711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790824852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 BRANT AVE",
            "address_2": "SUITE #4",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "07066",
            "telephone_number": "732-815-1711",
            "fax_number": "973-465-3701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 BRANT AVE",
            "address_2": "SUITE #4",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "07066",
            "telephone_number": "732-815-1711",
            "fax_number": "973-465-3701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DASILVA",
        "first_name": "JOHN",
        "middle_name": "VIEIRA",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00370000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clark, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.