Provider Demographics
NPI:1659641710
Name:DR. DAVID R. SLAVENS, P.A.
Entity Type:Organization
Organization Name:DR. DAVID R. SLAVENS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:SLAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-432-9909
Mailing Address - Street 1:16450 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5307
Mailing Address - Country:US
Mailing Address - Phone:239-432-9909
Mailing Address - Fax:239-433-0289
Practice Address - Street 1:16450 S TAMIAMI TRL
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-5307
Practice Address - Country:US
Practice Address - Phone:239-432-9909
Practice Address - Fax:239-433-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22034Medicare PIN