MEDICARE: JEFFREY ROBERT SLAGLE

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	2301010847	MI

General Provider Information

NPI Number	:	1932756798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY ROBERT SLAGLE

Provider Business Mailing Address
First Line	:	41175 JUSTIN DR
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-2072
Country	:	US
Telephone Number	:	931-319-8120
Fax Number	:

Provider Business Practice Location Address
First Line	:	45637 HAYES RD
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48315-6214
Country	:	US
Telephone Number	:	586-991-6471
Fax Number	:

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

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	08/26/2019

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