Provider Demographics
NPI:1346567260
Name:SKK ENTERPRISES, LLC
Entity Type:Organization
Organization Name:SKK ENTERPRISES, LLC
Other - Org Name:ELEMENTS THERAPEUTIC MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-212-4337
Mailing Address - Street 1:10165 HENNEPIN TOWN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-3104
Mailing Address - Country:US
Mailing Address - Phone:952-405-6220
Mailing Address - Fax:
Practice Address - Street 1:10165 HENNEPIN TOWN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-3104
Practice Address - Country:US
Practice Address - Phone:952-405-6220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-02
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMA0000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty