Provider Demographics
NPI:1821356387
Name:SKALNICAN, STEPHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:
Last Name:SKALNICAN
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 1:455 E GRAND RIVER AVE # 204
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1551
Mailing Address - Country:US
Mailing Address - Phone:810-360-0338
Mailing Address - Fax:810-355-2600
Practice Address - Street 1:455 E GRAND RIVER AVE # 204
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1551
Practice Address - Country:US
Practice Address - Phone:810-360-0338
Practice Address - Fax:810-355-2600
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor