Provider Demographics
NPI:1538279070
Name:SKOW, PHILLIP M (DC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:M
Last Name:SKOW
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:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56159
Mailing Address - Country:US
Mailing Address - Phone:507-427-3878
Mailing Address - Fax:507-427-3531
Practice Address - Street 1:304 10TH ST N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN LAKE
Practice Address - State:MN
Practice Address - Zip Code:56159-1591
Practice Address - Country:US
Practice Address - Phone:507-427-3878
Practice Address - Fax:507-427-3531
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN555528100Medicaid
MN359000079Medicare ID - Type Unspecified
MN555528100Medicaid