Provider Demographics
NPI:1801826540
Name:GASPARRE, SALVATORE PETER JR (DC)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:PETER
Last Name:GASPARRE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:SALVATORE
Other - Middle Name:PETER
Other - Last Name:GASPARRE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1755 ORANGE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3130
Mailing Address - Country:US
Mailing Address - Phone:949-631-0151
Mailing Address - Fax:949-631-0153
Practice Address - Street 1:1755 ORANGE AVE STE A
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3130
Practice Address - Country:US
Practice Address - Phone:949-631-0151
Practice Address - Fax:949-631-0153
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV07134Medicare UPIN