Provider Demographics
NPI:1689424566
Name:SLIPKOVICH, DYLAN MARCO
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:MARCO
Last Name:SLIPKOVICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4962 LOCKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-3748
Mailing Address - Country:US
Mailing Address - Phone:330-502-0476
Mailing Address - Fax:
Practice Address - Street 1:4962 LOCKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-3748
Practice Address - Country:US
Practice Address - Phone:330-502-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health