Provider Demographics
NPI:1134341498
Name:VEGA, J SALVADORE (DC)
Entity type:Individual
Prefix:DR
First Name:J
Middle Name:SALVADORE
Last Name:VEGA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:J
Other - Middle Name:SALVADORE
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TMP
Mailing Address - Street 1:1076 REED AVE
Mailing Address - Street 2:STE 76
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-8464
Mailing Address - Country:US
Mailing Address - Phone:650-248-3545
Mailing Address - Fax:
Practice Address - Street 1:1472 ODDSTAD DR
Practice Address - Street 2:STE 9
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2607
Practice Address - Country:US
Practice Address - Phone:650-248-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27880111NR0400X
CA210330225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist