Provider Demographics
NPI:1962405886
Name:SLAYTON, JOHN W (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:SLAYTON
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 1:2233A N BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2205
Mailing Address - Country:US
Mailing Address - Phone:816-233-9445
Mailing Address - Fax:816-233-9301
Practice Address - Street 1:2233A N BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2205
Practice Address - Country:US
Practice Address - Phone:816-233-9445
Practice Address - Fax:816-233-9301
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
07924013OtherBLUECROSS BLUESHIELD
MO753251206Medicaid
MO004274OtherCHIROPRACTIC LICENSE
MO753251206Medicaid
004162Medicare ID - Type UnspecifiedMEDICARE ID
07924013OtherBLUECROSS BLUESHIELD
43-1342691OtherEIN