Provider Demographics
NPI:1932105343
Name:SALA, RAYMOND J (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:SALA
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 1:765 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1545
Mailing Address - Country:US
Mailing Address - Phone:989-673-5559
Mailing Address - Fax:
Practice Address - Street 1:765 N STATE ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1545
Practice Address - Country:US
Practice Address - Phone:989-673-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRS004618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2121130Medicaid
MI0G95010Medicare PIN
MI2121130Medicaid