Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 396 | LA |
NPI | 1184724635 |
---|---|
Provider Name | Dr. Salvadore Rosario Giangrosso |
First Address | Covington, LA 70433-3346 |
Second Address | Covington, LA 70433-3346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1955507 | (05) | LA |
19997 | (02) | LA |