Provider Demographics
NPI:1275677122
Name:SKOCIK CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:SKOCIK CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SKOCIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-540-8448
Mailing Address - Street 1:5431 JONESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-4062
Mailing Address - Country:US
Mailing Address - Phone:717-540-8448
Mailing Address - Fax:717-540-6233
Practice Address - Street 1:5431 JONESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-4062
Practice Address - Country:US
Practice Address - Phone:717-540-8448
Practice Address - Fax:717-540-6233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 003615 L111N00000X, 111NR0200X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2202304OtherAETNA GP #
PA02761200OtherCAPITAL BLUE CROSS GP #
PA856258OtherHIGHMARK BLUE SHIELD GP#
PA02761200OtherCAPITAL BLUE CROSS GP #
PASK830155Medicare ID - Type Unspecified