Provider Demographics
NPI:1881889756
Name:SLAUGHTER CHIROPRACTIC
Entity type:Organization
Organization Name:SLAUGHTER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKALE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SLAUGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-341-9453
Mailing Address - Street 1:2021 N MAYS ST
Mailing Address - Street 2:# 900
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2147
Mailing Address - Country:US
Mailing Address - Phone:512-341-9453
Mailing Address - Fax:512-341-9550
Practice Address - Street 1:2021 N MAYS ST
Practice Address - Street 2:# 900
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2147
Practice Address - Country:US
Practice Address - Phone:512-341-9453
Practice Address - Fax:512-341-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8382261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00468ZMedicare PIN