Provider Demographics
NPI:1356522858
Name:SLAYMAKER CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:SLAYMAKER CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SLAYMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-363-2566
Mailing Address - Street 1:1803 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5434
Mailing Address - Country:US
Mailing Address - Phone:319-363-2566
Mailing Address - Fax:
Practice Address - Street 1:1803 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5434
Practice Address - Country:US
Practice Address - Phone:319-363-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA06531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0286039Medicaid
IA30557OtherBLUE CROSS BLUE SHIELD ID
IA0286039Medicaid
IAU92267Medicare UPIN
IAI9106Medicare PIN