Provider Demographics
NPI:1225031834
Name:SKIPPER, STERLING LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:STERLING
Middle Name:LEE
Last Name:SKIPPER
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 1:109 LILY ST
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-1475
Mailing Address - Country:US
Mailing Address - Phone:606-365-0203
Mailing Address - Fax:606-365-0208
Practice Address - Street 1:109 LILY ST
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1475
Practice Address - Country:US
Practice Address - Phone:606-365-0203
Practice Address - Fax:606-365-0208
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2013-08-09
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
KY4607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000349374OtherBLUE CARD #
KYDC4141OtherRAIL ROAD MEDICARE GROUP
KY619174OtherACN #
KY85001279Medicaid
KY619174OtherACN #