Provider Demographics
NPI:1245419753
Name:SLAVIN, JACQUI G (DC)
Entity type:Individual
Prefix:
First Name:JACQUI
Middle Name:G
Last Name:SLAVIN
Suffix:
Gender:F
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:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-0085
Mailing Address - Country:US
Mailing Address - Phone:970-376-7779
Mailing Address - Fax:
Practice Address - Street 1:916 S MAIN ST
Practice Address - Street 2:205
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6671
Practice Address - Country:US
Practice Address - Phone:720-204-6960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR6223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor