Provider Demographics
NPI:1245236751
Name:SLATTERY, TODD M (DC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:M
Last Name:SLATTERY
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 1:1608 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-6702
Mailing Address - Country:US
Mailing Address - Phone:563-242-2002
Mailing Address - Fax:563-242-2772
Practice Address - Street 1:1608 S 19TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-6702
Practice Address - Country:US
Practice Address - Phone:563-242-2002
Practice Address - Fax:563-242-2772
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-11-13
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
IA06262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15762OtherWELLMARK BCBS
IA15762OtherWELLMARK BCBS
IAU79015Medicare UPIN