Doctor Name: | KENNETH DALE SLACK |
NPI Number: | 1548375637 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MD2003-0686 |
Business Practice Address: | 1813 Cheyenne Ave Loveland, CO - 805384244 |
Business Phone Number: | 9702036801 |
Business Fax Number: | 9702036821 |
Mailing Address: | 1627 E 18th St, LOVELAND |
State: | CO |
Postal Code: | 805384209 |
Phone Number: | 9706630135 |
Fax Number: | 9704611422 |
NPI Enumeration Date: | 08/20/2006 |
NPI Last Update Date: | 01/24/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MD2003-0686 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NM |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |