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General NPI Number Information
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NPI Number | 1154037109
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Entity Type | Individual
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Provider Name | MATTHEW DAVID SALAS GERONIMO DC
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Gender | Male
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 6735 CONROY RD STE 211
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City | ORLANDO
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State | FL
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Zip | 32835-3571
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Country | US
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Telephone | 407-723-8142
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Fax |
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Provider Business Mailing Address
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Address Line | 6563 ROSECLIFF DR APT 100
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City | ORLANDO
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State | FL
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Zip | 32835-2928
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Country | US
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Telephone | 407-982-0845
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 14371
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License Number State | FL
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