Provider Demographics
NPI:1821239641
Name:SLOCUM CHIROPRACTIC PA
Entity Type:Organization
Organization Name:SLOCUM CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-725-4222
Mailing Address - Street 1:26 BATH RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2618
Mailing Address - Country:US
Mailing Address - Phone:207-725-4222
Mailing Address - Fax:207-319-7046
Practice Address - Street 1:26 BATH RD STE 1
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2618
Practice Address - Country:US
Practice Address - Phone:207-725-4222
Practice Address - Fax:207-319-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR815111N00000X
MECR912111N00000X
MECR2038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME122380000Medicaid
ME122380000Medicaid