Healthcare Provider Details

I. General information

NPI: 1598984205
Provider Name (Legal Business Name): SALT FAMILY CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 FENTON ST SUITE 206
CHULA VISTA CA
91914-3599
US

IV. Provider business mailing address

272 CHURCH AVE SUITE 1
CHULA VISTA CA
91910-2718
US

V. Phone/Fax

Practice location:
  • Phone: 619-420-7858
  • Fax: 619-420-4569
Mailing address:
  • Phone: 619-420-7858
  • Fax: 619-420-4569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number22840
License Number StateCA

VIII. Authorized Official

Name: DR. MARK DUNCAN SALT
Title or Position: PRESIDENT
Credential: D.C.
Phone: 619-420-7858