Provider Demographics
NPI:1184162885
Name:SKANE, DAVID RUSSELL (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RUSSELL
Last Name:SKANE
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 1:14460 QUAILRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-7219
Mailing Address - Country:US
Mailing Address - Phone:951-318-0087
Mailing Address - Fax:
Practice Address - Street 1:6794 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3022
Practice Address - Country:US
Practice Address - Phone:951-267-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor