Provider Demographics
NPI:1770110223
Name:SLATER, JAKOB (DC)
Entity type:Individual
Prefix:DR
First Name:JAKOB
Middle Name:
Last Name:SLATER
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 1:1825 MADISON ST STE D
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6589
Mailing Address - Country:US
Mailing Address - Phone:931-444-1236
Mailing Address - Fax:
Practice Address - Street 1:1825 MADISON ST STE D
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6589
Practice Address - Country:US
Practice Address - Phone:931-444-1236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor