Provider Demographics
NPI:1952521130
Name:DESALVO, DOUGLAS ARCHER (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ARCHER
Last Name:DESALVO
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 1:7595 REDWOOD BLVD
Mailing Address - Street 2:STE108
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-7700
Mailing Address - Country:US
Mailing Address - Phone:415-898-6888
Mailing Address - Fax:415-898-8474
Practice Address - Street 1:7595 REDWOOD BLVD
Practice Address - Street 2:STE 108
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-7700
Practice Address - Country:US
Practice Address - Phone:415-898-6888
Practice Address - Fax:415-898-8474
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor