Provider Demographics
NPI:1396765665
Name:SALVAGIO, LOUIS PETER (DC)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:PETER
Last Name:SALVAGIO
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 1:1543 KINGSLEY AVE
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4535
Mailing Address - Country:US
Mailing Address - Phone:904-264-0770
Mailing Address - Fax:904-264-0670
Practice Address - Street 1:1543 KINGSLEY AVE
Practice Address - Street 2:BUILDING 3
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4535
Practice Address - Country:US
Practice Address - Phone:904-264-0770
Practice Address - Fax:904-264-0670
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6772111N00000X, 111N00000X
FLCH 6772208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013405600Medicaid
FL013405600Medicaid
FL59-3260732OtherEIN