Provider Demographics
NPI:1427080183
Name:SLOCUM, DUSTIN A (DC)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:A
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:04011-2604
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:04011-2604
Practice Address - Country:US
Practice Address - Phone:207-725-4222
Practice Address - Fax:207-319-7046
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMGD919OtherHARVARD PILGRIM
ME3000020OtherCIGNA HEALTHCARE
ME036888OtherANTHEM
ME122380000Medicaid
ME122380000Medicaid