Provider Demographics
NPI:1760533657
Name:SKARBO, CHERYL ANN (DC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:SKARBO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MCMORRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3809
Mailing Address - Country:US
Mailing Address - Phone:810-987-4740
Mailing Address - Fax:
Practice Address - Street 1:401 MCMORRAN BLVD
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3809
Practice Address - Country:US
Practice Address - Phone:810-987-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1965116Medicaid
MI1965116Medicaid