1790875508 NPI number — DR. SEAN C SALAZAR DC

Table of content: DR. SEAN C SALAZAR DC (NPI 1790875508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790875508 NPI number — DR. SEAN C SALAZAR DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALAZAR
Provider First Name:
SEAN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1790875508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8988 S SHERIDAN RD STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74133-5035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-340-7871
Provider Business Mailing Address Fax Number:
918-340-7910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8988 S SHERIDAN RD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74133-5035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-340-7871
Provider Business Practice Location Address Fax Number:
918-340-7910
Provider Enumeration Date:
10/13/2006

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 , with the licence number:  CH00034408 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 4398 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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