Provider Demographics
NPI:1982110011
Name:SLUTAK CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SLUTAK CHIROPRACTIC LLC
Other - Org Name:LEVAN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SLUTAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-558-3500
Mailing Address - Street 1:1000 BRIARSDALE RD STE C
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5900
Mailing Address - Country:US
Mailing Address - Phone:717-558-3500
Mailing Address - Fax:717-558-3505
Practice Address - Street 1:1000 BRIARSDALE RD STE C
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5900
Practice Address - Country:US
Practice Address - Phone:717-558-3500
Practice Address - Fax:717-558-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty