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General NPI Number Information
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NPI Number | 1417315441
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Entity Type | Organization
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Legal Business Name | SEAN SALAZAR
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 14375 SARATOGA AVE STE 101
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City | SARATOGA
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State | CA
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Zip | 95070-5978
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Country | US
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Telephone | 408-634-2096
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Fax |
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Provider Business Mailing Address
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Address Line | 20990 VALLEY GREEN DR APT 704
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City | CUPERTINO
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State | CA
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Zip | 95014-1846
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Country | US
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Telephone | 970-391-0068
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | SEAN ROBERT SALAZAR
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Credential | DC
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Telephone | 970-391-0068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 33459
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License Number State | CA
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