MEDICARE: SEAN SALAZAR

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	33459	CA

General Provider Information

NPI Number	:	1417315441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEAN SALAZAR

Provider Business Mailing Address
First Line	:	20990 VALLEY GREEN DR APT 704
Second Line	:
City	:	CUPERTINO
State	:	CA
Zip	:	95014-1846
Country	:	US
Telephone Number	:	970-391-0068
Fax Number	:

Provider Business Practice Location Address
First Line	:	14375 SARATOGA AVE STE 101
Second Line	:
City	:	SARATOGA
State	:	CA
Zip	:	95070-5978
Country	:	US
Telephone Number	:	408-634-2096
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	SEAN ROBERT SALAZAR
Credential	:	DC
Telephone Number	:	970-391-0068

Provider Enumeration Date	:	02/04/2016
Last Update Date	:	11/14/2019

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Directions to “SEAN SALAZAR ” Practice Location

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