Provider Demographics
NPI:1740244003
Name:SKINNER, KEVIN L (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:SKINNER
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 1:3312 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-2502
Mailing Address - Country:US
Mailing Address - Phone:501-339-1609
Mailing Address - Fax:
Practice Address - Street 1:701 N PRESTON RD STE 330
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-3812
Practice Address - Country:US
Practice Address - Phone:501-339-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158581718Medicaid
5Y530Medicare ID - Type Unspecified
V03374Medicare UPIN