Provider Demographics
NPI:1417942525
Name:SKARDA, STEPHEN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:THOMAS
Last Name:SKARDA
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 1:1431 OAKLAND BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-8403
Mailing Address - Country:US
Mailing Address - Phone:925-947-5770
Mailing Address - Fax:925-947-0544
Practice Address - Street 1:1431 OAKLAND BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8403
Practice Address - Country:US
Practice Address - Phone:925-947-5770
Practice Address - Fax:925-947-0544
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATO3976Medicare UPIN
CADC0105540Medicare ID - Type Unspecified