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General NPI Number Information
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NPI Number | 1780764142
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Entity Type | Organization
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Legal Business Name | SLINDE CHIROPRACTIC DC SC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 1317 E MAIN ST
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City | STOUGHTON
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State | WI
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Zip | 53589
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Country | US
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Telephone | 608-877-8465
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Fax | 608-205-1908
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Provider Business Mailing Address
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Address Line | 1317 E MAIN ST
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City | STOUGHTON
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State | WI
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Zip | 53589
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Country | US
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Telephone | 608-877-8465
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Fax | 608-205-1908
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Authorized Official
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Title or Position | PRESIDENT
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Name | DERREN LUTHER SLINDE
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Credential | DC
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Telephone | 608-877-8465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3513012
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License Number State | WI
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