Provider Demographics
NPI:1316546591
Name:GONZALEZ RUIZ, SALVADOR (DC)
Entity Type:Individual
Prefix:
First Name:SALVADOR
Middle Name:
Last Name:GONZALEZ RUIZ
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 1:1775 WINDSOR RD APT 438
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3077
Mailing Address - Country:US
Mailing Address - Phone:347-510-2343
Mailing Address - Fax:
Practice Address - Street 1:758 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6710
Practice Address - Country:US
Practice Address - Phone:862-702-8929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00770800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ38MC00770800OtherCHIROPRACTIC LICENSE