Provider Demographics
NPI:1225277437
Name:SKOCIK, MIMI RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:MIMI
Middle Name:RENEE
Last Name:SKOCIK
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 1:1111A S GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-6903
Mailing Address - Country:US
Mailing Address - Phone:302-734-2225
Mailing Address - Fax:302-734-2227
Practice Address - Street 1:1111A S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6903
Practice Address - Country:US
Practice Address - Phone:302-734-2225
Practice Address - Fax:302-734-2227
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009994111N00000X
DEF1-0000724111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111N00000XChiropractic ProvidersChiropractor