Provider Demographics
NPI:1295001519
Name:SKUPAKA, JON ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:ROBERT
Last Name:SKUPAKA
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 1:3722 WILLIAM PENN AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15909-4237
Mailing Address - Country:US
Mailing Address - Phone:724-840-6015
Mailing Address - Fax:814-749-0869
Practice Address - Street 1:3722 WILLIAM PENN AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15909-4237
Practice Address - Country:US
Practice Address - Phone:724-840-6015
Practice Address - Fax:814-749-0869
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA010586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor