Provider Demographics
NPI:1790905081
Name:SALERA, EDMOND EUGENE
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:EUGENE
Last Name:SALERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:96008
Mailing Address - Country:US
Mailing Address - Phone:530-549-4402
Mailing Address - Fax:
Practice Address - Street 1:23 DESCHUTES RD
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:CA
Practice Address - Zip Code:96008
Practice Address - Country:US
Practice Address - Phone:530-549-4402
Practice Address - Fax:530-549-3295
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor