Provider Demographics
NPI:1538206651
Name:SLAM INC
Entity type:Organization
Organization Name:SLAM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WD
Authorized Official - Last Name:ARELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-966-3949
Mailing Address - Street 1:6917 W LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-5512
Mailing Address - Country:US
Mailing Address - Phone:509-966-3949
Mailing Address - Fax:
Practice Address - Street 1:120 N 50TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2800
Practice Address - Country:US
Practice Address - Phone:509-972-4422
Practice Address - Fax:509-972-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU98735Medicare UPIN