Provider Demographics
NPI:1841381654
Name:TRI-STATE CHIROPRACTIC
Entity Type:Organization
Organization Name:TRI-STATE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SLUSARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-416-7478
Mailing Address - Street 1:2014 N WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-9102
Mailing Address - Country:US
Mailing Address - Phone:260-665-3106
Mailing Address - Fax:
Practice Address - Street 1:2014 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-9102
Practice Address - Country:US
Practice Address - Phone:260-665-3106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002459A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU98926Medicare UPIN
SC7899Medicare ID - Type Unspecified