Provider Demographics
NPI:1811199144
Name:SLEBODNIK, DAVID JOHN (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:SLEBODNIK
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 1:20260 N 59TH AVE
Mailing Address - Street 2:#102
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6845
Mailing Address - Country:US
Mailing Address - Phone:623-561-9111
Mailing Address - Fax:
Practice Address - Street 1:20260 N 59TH AVE
Practice Address - Street 2:#102
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6845
Practice Address - Country:US
Practice Address - Phone:623-561-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0236530OtherBCBS NUMBER
AZDC4955Medicare ID - Type Unspecified