Provider Demographics
NPI:1659395994
Name:SLAVIN, PETER (DC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SLAVIN
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 1:8269 W GOLF RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1156
Mailing Address - Country:US
Mailing Address - Phone:847-299-7000
Mailing Address - Fax:847-299-7007
Practice Address - Street 1:8269 W GOLF RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1156
Practice Address - Country:US
Practice Address - Phone:847-299-7000
Practice Address - Fax:847-299-7007
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632135OtherBCBS#
ILK16049OtherMEDICARE PIN#
IL038-009528OtherLICENSE #
IL364482046-60714-01Medicaid
IL364482046-60714-01Medicaid