Provider Demographics
NPI:1790039105
Name:SKUTLEY, CORINNE R (DC)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:R
Last Name:SKUTLEY
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 1:7103 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1436
Mailing Address - Country:US
Mailing Address - Phone:619-668-0833
Mailing Address - Fax:619-668-0686
Practice Address - Street 1:7103 BROADWAY
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1436
Practice Address - Country:US
Practice Address - Phone:619-668-0833
Practice Address - Fax:619-668-0686
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor