Provider Demographics
NPI:1356468532
Name:SALHOLM, KENT S (DC)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:S
Last Name:SALHOLM
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 1:12460 EUCLID ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-3351
Mailing Address - Country:US
Mailing Address - Phone:714-638-4852
Mailing Address - Fax:714-638-4127
Practice Address - Street 1:12460 EUCLID ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3351
Practice Address - Country:US
Practice Address - Phone:714-638-4852
Practice Address - Fax:714-638-4127
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330264772OtherEMPLOYER IID NUMBER
CAT18709Medicare UPIN
CAW14388Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER