Provider Demographics
NPI:1396823787
Name:SKURKA, JAMIE PETER (DC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:PETER
Last Name:SKURKA
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 1:150 ISLIP AVENUE ROUTE 111
Mailing Address - Street 2:SUITE #10
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751
Mailing Address - Country:US
Mailing Address - Phone:630-859-3420
Mailing Address - Fax:631-859-0316
Practice Address - Street 1:150 ISLIP AVENUE ROUTE 111
Practice Address - Street 2:SUITE #10
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751
Practice Address - Country:US
Practice Address - Phone:630-859-3420
Practice Address - Fax:631-859-0316
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U18148Medicare UPIN
X46592Medicare ID - Type Unspecified