Provider Demographics
NPI:1982865747
Name:SKINNER, SEAN PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PATRICK
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 1:6206 PETERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4026
Mailing Address - Country:US
Mailing Address - Phone:540-563-0334
Mailing Address - Fax:540-563-0122
Practice Address - Street 1:6206 PETERS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-4026
Practice Address - Country:US
Practice Address - Phone:540-563-0334
Practice Address - Fax:540-563-0122
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556699111N00000X
390200000X
NY011636111N00000X
NC3917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program