Provider Demographics
NPI:1144522400
Name:SLAYTON CHIROPRACTIC CLINIC P.A.
Entity type:Organization
Organization Name:SLAYTON CHIROPRACTIC CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MAE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:LINDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-836-8911
Mailing Address - Street 1:2002 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SLAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:56172-2011
Mailing Address - Country:US
Mailing Address - Phone:507-836-8911
Mailing Address - Fax:507-836-8920
Practice Address - Street 1:2002 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SLAYTON
Practice Address - State:MN
Practice Address - Zip Code:56172-2011
Practice Address - Country:US
Practice Address - Phone:507-836-8911
Practice Address - Fax:507-836-8920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU19834Medicare UPIN
MN64819Medicare PIN