Healthcare Provider Details

I. General information

NPI: 1528219979
Provider Name (Legal Business Name): STEFAN SALIM D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3462 UNION AVE
SAN JOSE CA
95124-2011
US

IV. Provider business mailing address

3462 UNION AVE
SAN JOSE CA
95124-2011
US

V. Phone/Fax

Practice location:
  • Phone: 408-369-1533
  • Fax:
Mailing address:
  • Phone: 408-369-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number25174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: