Provider Demographics
NPI:1912061524
Name:SLAK, JEAN-MARC (DC)
Entity Type:Individual
Prefix:DR
First Name:JEAN-MARC
Middle Name:
Last Name:SLAK
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 1:23 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4916
Mailing Address - Country:US
Mailing Address - Phone:781-273-0099
Mailing Address - Fax:781-273-3859
Practice Address - Street 1:23 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4916
Practice Address - Country:US
Practice Address - Phone:781-273-0099
Practice Address - Fax:781-273-3859
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1235111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35862Medicare ID - Type Unspecified