Provider Demographics
NPI:1841356680
Name:SLATOR, MARY ANNE (DC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANNE
Last Name:SLATOR
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 1:5622 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:MUNNSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13409-4024
Mailing Address - Country:US
Mailing Address - Phone:315-495-2661
Mailing Address - Fax:
Practice Address - Street 1:5622 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:MUNNSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13409-4024
Practice Address - Country:US
Practice Address - Phone:315-495-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004918-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO4918-1OtherWORKER'S COMP AUTH.
NYX004918-1OtherLICENSE NUMBER
NY51065BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER