Provider Demographics
NPI:1710072632
Name:SALEM, GREGORY J (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:SALEM
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 1:13891 NEWPORT AVE
Mailing Address - Street 2:STE 290
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7835
Mailing Address - Country:US
Mailing Address - Phone:714-832-4010
Mailing Address - Fax:714-515-5969
Practice Address - Street 1:13882 NEWPORT AVE STE B
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4666
Practice Address - Country:US
Practice Address - Phone:714-832-4010
Practice Address - Fax:714-832-2423
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17986Medicare PIN