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NPI Code Detail

MEDICARE: KENT D VANDERSLICE DC PC

MEDICARE: KENT D VANDERSLICE DC PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor006287GA

General Provider Information

NPI Number : 1730453176
Entity Type Code : Organization
Provider Name (Legal Business Name) : KENT D VANDERSLICE DC PC
Provider Business Mailing Address
First Line : 185 REGINA CIR SW
Second Line :
City : MARIETTA
State : GA
Zip : 30064-3271
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1135 S MARIETTA PKWY SE
Second Line :
City : MARIETTA
State : GA
Zip : 30060-2811
Country : US
Telephone Number : 770-422-1059
Fax Number : 770-422-4626
Authorized Official
Title or Position : OWNER
Name : DR. KENT D VANDERSLICE
Credential : DC
Telephone Number : 404-713-8883
Provider Enumeration Date : 03/02/2012
Last Update Date : 03/02/2012

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Directions to “KENT D VANDERSLICE DC PC ” Practice Location

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