Provider Demographics
NPI:1629087291
Name:SLOMOVIC, EDWARD LEON (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEON
Last Name:SLOMOVIC
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 1:3291 TRUXEL ROAD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833
Mailing Address - Country:US
Mailing Address - Phone:916-929-1216
Mailing Address - Fax:916-929-8776
Practice Address - Street 1:3291 TRUXEL ROAD
Practice Address - Street 2:SUITE 14
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833
Practice Address - Country:US
Practice Address - Phone:916-929-1216
Practice Address - Fax:916-929-8776
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0218050Medicare ID - Type Unspecified
U56276Medicare UPIN