=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982062915
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN ROBERT SALAZAR DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2016
-----------------------------------------------------
Last Update Date | 11/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14375 SARATOGA AVE STE 101
-----------------------------------------------------
City | SARATOGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95070-5978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-634-2096
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20990 VALLEY GREEN DR APT 704
-----------------------------------------------------
City | CUPERTINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95014-1846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-391-0068
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | 33459
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------