Provider Demographics
NPI:1104042332
Name:SALDIVAR, JOSE JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:SALDIVAR
Suffix:JR
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 1:2101 SMOKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1037
Mailing Address - Country:US
Mailing Address - Phone:714-529-0700
Mailing Address - Fax:714-529-0722
Practice Address - Street 1:420 W CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3001
Practice Address - Country:US
Practice Address - Phone:714-529-0700
Practice Address - Fax:714-529-0722
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 23974111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU60959Medicare UPIN