Provider Demographics
NPI:1184732430
Name:DANIELE, SALVATORE COSIMO (BS, D,C)
Entity type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:COSIMO
Last Name:DANIELE
Suffix:
Gender:M
Credentials:BS, D,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 WESTWOOD SHOPPING CTR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1532
Mailing Address - Country:US
Mailing Address - Phone:910-480-1111
Mailing Address - Fax:910-480-1113
Practice Address - Street 1:1905 SKIBO RD STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0261
Practice Address - Country:US
Practice Address - Phone:910-480-1111
Practice Address - Fax:910-480-1113
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3330111N00000X
TXDC 9102111N00000X
RIDCP 00456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2457877OtherMEDICARE INDIVIDUAL PTAN
NC662673OtherAMERICAN CHIRO. NETWORK
NC085UXOtherBLUE CROSS/BLUE SHIELD
NC607554400OtherACS-DEPT. OF LABOR
NC2457877OtherMEDICARE GROUP/ORGANIZATION PTAN
NC89085UXMedicaid
NC89085UXMedicaid