Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5956 | AZ |
N | 111NR0400X | Rehabilitation Chiropractor | 3566 | AZ |
NPI | 1346304821 |
---|---|
Provider Name | Oryan Salberg |
First Address | Prescott, AZ 86301-3026 |
Second Address | Prescott, AZ 86301-3026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 22/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U75525 | (02) | AZ |