MEDICARE: DR. KEITH R SLAYMAKER DC

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
1	111N00000X	Chiropractor	IA06531	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	30557	OTHER	IA	WELLMARK BCBS
3	371458044	OTHER		US GOV TAX ID #

General Provider Information

NPI Number	:	1801854518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH R SLAYMAKER DC

Provider Business Mailing Address
First Line	:	1803 1ST AVE SE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-5434
Country	:	US
Telephone Number	:	319-363-2566
Fax Number	:

Provider Business Practice Location Address
First Line	:	1803 1ST AVE SE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-5434
Country	:	US
Telephone Number	:	319-363-2566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	01/19/2011

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