Provider Demographics
NPI:1619960895
Name:DESALVO, DAVID (DC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:DESALVO
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 1:875 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-2332
Mailing Address - Country:US
Mailing Address - Phone:408-996-8562
Mailing Address - Fax:
Practice Address - Street 1:875 SARATOGA AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-2332
Practice Address - Country:US
Practice Address - Phone:408-996-8562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC018220Medicare UPIN
CADC018220Medicare ID - Type UnspecifiedCHIROPRACTOR