Provider Demographics
NPI:1013930775
Name:MARTINGANO, SALVATORE J (DC)
Entity type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:J
Last Name:MARTINGANO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2392 N RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3619
Mailing Address - Country:US
Mailing Address - Phone:321-773-1584
Mailing Address - Fax:321-676-6049
Practice Address - Street 1:1320 PALM BAY RD NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3837
Practice Address - Country:US
Practice Address - Phone:321-729-9430
Practice Address - Fax:321-676-6049
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 5140111N00000X
SC1028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U69410OtherRAILROAD MEDICARE
FL70731OtherBLUE CROSS/SHIELD PROVIDE
FLT94445Medicare UPIN
FL70731Medicare ID - Type UnspecifiedPROVIDER NUMBER