Provider Demographics
NPI:1013008762
Name:SKON, WILLIAM HENRY (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:SKON
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 1:1567 SELBY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6304
Mailing Address - Country:US
Mailing Address - Phone:651-644-3900
Mailing Address - Fax:651-644-8969
Practice Address - Street 1:1567 SELBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6304
Practice Address - Country:US
Practice Address - Phone:651-644-3900
Practice Address - Fax:651-644-8969
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN066910000Medicaid
MNDP2418OtherRAILROAD MEDICARE PTAN
MN066910000Medicaid