Healthcare Provider Details

I. General information

NPI: 1083998249
Provider Name (Legal Business Name): SALEGO ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 UNION AVE SUITE NUMBER 2
NATRONA HEIGHTS PA
15065-2143
US

IV. Provider business mailing address

105 EKASTOWN RD
SARVER PA
16055-9404
US

V. Phone/Fax

Practice location:
  • Phone: 843-640-9758
  • Fax:
Mailing address:
  • Phone: 843-640-9758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC010444
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC010444
License Number StatePA

VIII. Authorized Official

Name: DR. JOEL J SALEGO
Title or Position: PRESIDENT
Credential: DC
Phone: 843-640-9758