Provider Demographics
NPI:1609048685
Name:SLATE, LARRY JOE (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JOE
Last Name:SLATE
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 1:1688 CUMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-6059
Mailing Address - Country:US
Mailing Address - Phone:630-236-9271
Mailing Address - Fax:
Practice Address - Street 1:1688 CUMBERLAND DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-6059
Practice Address - Country:US
Practice Address - Phone:630-236-9271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor