Healthcare Provider Details

I. General information

NPI: 1487613584
Provider Name (Legal Business Name): DARDANELLA SLAVIN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 STATE RD UNIT 12
VINEYARD HAVEN MA
02568-5621
US

IV. Provider business mailing address

455 STATE RD PMB 133
VINEYARD HAVEN MA
02568-5621
US

V. Phone/Fax

Practice location:
  • Phone: 508-696-1863
  • Fax:
Mailing address:
  • Phone: 508-696-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3056
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: