MEDICARE: SALEGO ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	DC010444	PA
2	111NN1001X	Nutrition Chiropractor	DC010444

General Provider Information

NPI Number	:	1083998249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEGO ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	105 EKASTOWN RD
Second Line	:
City	:	SARVER
State	:	PA
Zip	:	16055-9404
Country	:	US
Telephone Number	:	843-640-9758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1627 UNION AVE
Second Line	:	SUITE NUMBER 2
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2143
Country	:	US
Telephone Number	:	843-640-9758
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOEL J SALEGO
Credential	:	DC
Telephone Number	:	843-640-9758

Provider Enumeration Date	:	10/06/2011
Last Update Date	:	10/06/2011

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