Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHIA-1964 | ID |
NPI | 1376186148 |
---|---|
Provider Name | Miguel Salgado-Gonzales |
First Address | Medford, OR 97504-5576 |
Second Address | Boise, ID 83709-1610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2019 |
Last Update Date | 26/08/2021 |