Provider Demographics
NPI:1639486103
Name:PORTERA, VINCENT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:PORTERA
Suffix:JR
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 1:551 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3302
Mailing Address - Country:US
Mailing Address - Phone:831-422-3558
Mailing Address - Fax:831-422-3020
Practice Address - Street 1:551 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3302
Practice Address - Country:US
Practice Address - Phone:831-422-3558
Practice Address - Fax:831-422-3020
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor