Provider Demographics
NPI:1386641504
Name:SALVATORE, JAMES GREGGORY (DC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GREGGORY
Last Name:SALVATORE
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 1:1613 NICHOLSON ST
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2426
Mailing Address - Country:US
Mailing Address - Phone:815-931-2579
Mailing Address - Fax:
Practice Address - Street 1:1000 ESSINGTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2841
Practice Address - Country:US
Practice Address - Phone:815-931-2579
Practice Address - Fax:815-744-1681
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7662849OtherAETNA PROVIDER NUMBER
IL0009932443OtherBLUECROSS BLUESHIELD IL
ILV09663Medicare UPIN
IL7662849OtherAETNA PROVIDER NUMBER