Provider Demographics
NPI:1528021409
Name:SLAUGHTER, MIKALE LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:MIKALE
Middle Name:LEE
Last Name:SLAUGHTER
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 1:2000 SAM BASS RD
Mailing Address - Street 2:SUITE 106 B
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1970
Mailing Address - Country:US
Mailing Address - Phone:512-947-6805
Mailing Address - Fax:512-341-9459
Practice Address - Street 1:2000 SAM BASS RD
Practice Address - Street 2:SUITE 106 B
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-1970
Practice Address - Country:US
Practice Address - Phone:512-947-6805
Practice Address - Fax:512-341-9459
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor