Provider Demographics
NPI:1851762033
Name:SALAZ, JAKE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAKE
Middle Name:
Last Name:SALAZ
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 1:25603 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-3305
Mailing Address - Country:US
Mailing Address - Phone:503-492-6851
Mailing Address - Fax:503-492-8567
Practice Address - Street 1:25603 SE STARK ST
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-3305
Practice Address - Country:US
Practice Address - Phone:503-492-6851
Practice Address - Fax:503-492-8567
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor