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General NPI Number Information
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NPI Number | 1265612741
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Entity Type | Organization
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Legal Business Name | SALEM CHIROPRACTIC PC
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 13891 NEWPORT AVE STE 290
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City | TUSTIN
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State | CA
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Zip | 92780-7835
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Country | US
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Telephone | 714-832-4010
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Fax | 714-515-5969
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Provider Business Mailing Address
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Address Line | 13882 NEWPORT AVE SUITE B
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City | TUSTIN
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State | CA
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Zip | 92780-4666
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Country | US
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Telephone | 714-832-4010
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Fax | 714-832-2423
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Authorized Official
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Title or Position | OWNER
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Name | MR. GREGORY J SALEM
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Credential | D.C.
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Telephone | 714-832-4010
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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 | DC17986
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License Number State | CA
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