Provider Demographics
NPI:1356617963
Name:SALETNIK, MARK (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SALETNIK
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 1:1620 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1620 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3479
Practice Address - Country:US
Practice Address - Phone:919-250-3330
Practice Address - Fax:919-250-9995
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
061686719Medicare UPIN