Provider Demographics
NPI:1467662742
Name:SKON CHIROPRACTIC PA
Entity Type:Organization
Organization Name:SKON CHIROPRACTIC PA
Other - Org Name:SKON CHIROPRACTIC INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:SKON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-644-3900
Mailing Address - Street 1:856 RAYMOND AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114
Mailing Address - Country:US
Mailing Address - Phone:651-644-3900
Mailing Address - Fax:651-644-8969
Practice Address - Street 1:856 RAYMOND AVE
Practice Address - Street 2:UNIT C
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114
Practice Address - Country:US
Practice Address - Phone:651-644-3900
Practice Address - Fax:651-644-8969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN066910000Medicaid