Healthcare Provider Details

I. General information

NPI: 1104815224
Provider Name (Legal Business Name): JEFFREY S SLOCUM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 BATH RD SUITE #1
BRUNSWICK ME
04011-2618
US

IV. Provider business mailing address

26 BATH RD SUITE #1
BRUNSWICK ME
04011-2618
US

V. Phone/Fax

Practice location:
  • Phone: 207-725-4222
  • Fax: 207-319-7046
Mailing address:
  • Phone: 207-725-4222
  • Fax: 207-319-7046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR912
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: