1386641504 NPI number — MR. JAMES GREGGORY SALVATORE D.C.

Table of content: MR. JAMES GREGGORY SALVATORE D.C. (NPI 1386641504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386641504 NPI number — MR. JAMES GREGGORY SALVATORE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALVATORE
Provider First Name:
JAMES
Provider Middle Name:
GREGGORY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386641504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1613 NICHOLSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CREST HILL
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60435-2426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-931-2579
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 ESSINGTON RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60435-2841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-931-2579
Provider Business Practice Location Address Fax Number:
815-744-1681
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7662849 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0009932443 . This is a "BLUECROSS BLUESHIELD IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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