Provider Demographics
NPI:1528212636
Name:E SALERA CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:E SALERA CHIROPRACTIC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:E
Authorized Official - Last Name:SALERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-302-3555
Mailing Address - Street 1:457 KNOLLCREST DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0121
Mailing Address - Country:US
Mailing Address - Phone:530-302-3555
Mailing Address - Fax:530-302-3601
Practice Address - Street 1:457 KNOLLCREST DR
Practice Address - Street 2:SUITE 120
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0121
Practice Address - Country:US
Practice Address - Phone:530-302-3555
Practice Address - Fax:530-302-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC01137000Medicare PIN