Provider Demographics
NPI:1104815224
Name:SLOCUM, JEFFREY S (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:SLOCUM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BATH RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2618
Mailing Address - Country:US
Mailing Address - Phone:207-725-4222
Mailing Address - Fax:207-319-7046
Practice Address - Street 1:26 BATH RD
Practice Address - Street 2:SUITE #1
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2618
Practice Address - Country:US
Practice Address - Phone:207-725-4222
Practice Address - Fax:207-319-7046
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME132180000Medicaid
MEM21506OtherCIGNA
ME2243348OtherAETNA HMO
ME034535OtherBCBS
MEM24165OtherHEALTHSOURCE
MEMGD920OtherHARVARD PILGRIM
ME034535OtherBCBS
MEMGD920OtherHARVARD PILGRIM