Provider Demographics
NPI:1689745366
Name:SLAUGHTER, MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:SLAUGHTER
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 1:225 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-3833
Mailing Address - Country:US
Mailing Address - Phone:904-368-0011
Mailing Address - Fax:904-368-0013
Practice Address - Street 1:225 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-3833
Practice Address - Country:US
Practice Address - Phone:904-368-0011
Practice Address - Fax:904-368-0013
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70023OtherBCBS
FL70023ZOtherMEDICARE PTAN