Provider Demographics
NPI:1780764142
Name:SLINDE CHIROPRACTIC DC SC
Entity type:Organization
Organization Name:SLINDE CHIROPRACTIC DC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERREN
Authorized Official - Middle Name:LUTHER
Authorized Official - Last Name:SLINDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-877-8465
Mailing Address - Street 1:1317 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589
Mailing Address - Country:US
Mailing Address - Phone:608-877-8465
Mailing Address - Fax:608-205-1908
Practice Address - Street 1:1317 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589
Practice Address - Country:US
Practice Address - Phone:608-877-8465
Practice Address - Fax:608-205-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3513012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035768Medicare ID - Type Unspecified
WI6622620001Medicare NSC
000035768Medicare UPIN