Provider Demographics
NPI:1801939525
Name:SALEM, SUSAN (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:SALEM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 NEWELL HILL PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5292
Mailing Address - Country:US
Mailing Address - Phone:925-933-1738
Mailing Address - Fax:925-933-3549
Practice Address - Street 1:1299 NEWELL HILL PL
Practice Address - Street 2:SUITE 102
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5292
Practice Address - Country:US
Practice Address - Phone:925-933-1738
Practice Address - Fax:925-933-3549
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23630Medicare ID - Type UnspecifiedMEDICARE NUMBER