Provider Demographics
NPI:1265506729
Name:SLOBODIAN, RITA (DC)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:SLOBODIAN
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 1:6233 SOQUEL DR STE D
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3184
Mailing Address - Country:US
Mailing Address - Phone:831-465-0160
Mailing Address - Fax:831-465-0161
Practice Address - Street 1:6233 SOQUEL DR STE D
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3184
Practice Address - Country:US
Practice Address - Phone:831-465-0160
Practice Address - Fax:831-465-0161
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0218040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0218040Medicare ID - Type Unspecified