Provider Demographics
NPI:1598907404
Name:VANG, SALAD (DC)
Entity Type:Individual
Prefix:DR
First Name:SALAD
Middle Name:
Last Name:VANG
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 1:2110 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-1434
Mailing Address - Country:US
Mailing Address - Phone:920-659-2840
Mailing Address - Fax:
Practice Address - Street 1:2110 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1434
Practice Address - Country:US
Practice Address - Phone:920-659-2840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4486012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIWI1413001Medicare PIN