Provider Demographics
NPI:1053452276
Name:SKINNER, ALISA D (DC)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:D
Last Name:SKINNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 OLD TROLLEY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5673
Mailing Address - Country:US
Mailing Address - Phone:843-851-8718
Mailing Address - Fax:
Practice Address - Street 1:627 OLD TROLLEY RD
Practice Address - Street 2:SUITE B
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5673
Practice Address - Country:US
Practice Address - Phone:843-851-8718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor