Provider Demographics
NPI:1154373439
Name:SAUL, AUDRA (DC)
Entity type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:
Last Name:SAUL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BOLLINGER CANYON WAY
Mailing Address - Street 2:A-15
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5251
Mailing Address - Country:US
Mailing Address - Phone:925-735-8508
Mailing Address - Fax:925-735-2374
Practice Address - Street 1:500 BOLLINGER CANYON WAY
Practice Address - Street 2:A-15
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5251
Practice Address - Country:US
Practice Address - Phone:925-735-8508
Practice Address - Fax:925-735-2374
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0235250Medicare ID - Type Unspecified