Provider Demographics
NPI:1346464690
Name:SLONE, MICHAEL J (DC, DACNB)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:SLONE
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4588 PERALTA BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5757
Mailing Address - Country:US
Mailing Address - Phone:510-793-4835
Mailing Address - Fax:510-793-6399
Practice Address - Street 1:4588 PERALTA BLVD STE 7
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5757
Practice Address - Country:US
Practice Address - Phone:510-793-4835
Practice Address - Fax:510-793-6399
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22169111NN0400X
CA1-12-12648103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0221690Medicare ID - Type Unspecified
CAU40288Medicare UPIN