Provider Demographics
NPI:1699844142
Name:SLATER, ROBERT CLARENCE SR (BA, MSC, DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLARENCE
Last Name:SLATER
Suffix:SR
Gender:M
Credentials:BA, MSC, DC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1036 CLEVELAND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1826
Mailing Address - Country:US
Mailing Address - Phone:651-699-3366
Mailing Address - Fax:651-699-5780
Practice Address - Street 1:1036 CLEVELAND AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1826
Practice Address - Country:US
Practice Address - Phone:651-699-3366
Practice Address - Fax:651-699-5780
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5018111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor