Provider Demographics
NPI:1417048091
Name:SKABO, JAMES A (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:SKABO
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 1:1650 N DYSART RD
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1116
Mailing Address - Country:US
Mailing Address - Phone:623-925-9045
Mailing Address - Fax:623-925-9047
Practice Address - Street 1:1650 N DYSART RD
Practice Address - Street 2:SUITE # 1
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1116
Practice Address - Country:US
Practice Address - Phone:623-925-9045
Practice Address - Fax:623-925-9047
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0939210OtherBLUE SHIELD
134241398OtherCOMMERCIAL CARRIERS
134241398OtherCOMMERCIAL CARRIERS
U84915Medicare UPIN