Provider Demographics
NPI:1184724635
Name:GIANGROSSO, SALVADORE ROSARIO (DC)
Entity type:Individual
Prefix:DR
First Name:SALVADORE
Middle Name:ROSARIO
Last Name:GIANGROSSO
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 1:618 S TYLER ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3346
Mailing Address - Country:US
Mailing Address - Phone:985-892-6544
Mailing Address - Fax:985-875-7519
Practice Address - Street 1:618 S TYLER ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3346
Practice Address - Country:US
Practice Address - Phone:985-892-6544
Practice Address - Fax:985-875-7519
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA396111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1955507Medicaid
LA19997Medicare UPIN
LA59249Medicare ID - Type UnspecifiedMEDICARE ID #