Provider Demographics
NPI:1255628509
Name:KEVIN L SKINNER DC PC
Entity type:Organization
Organization Name:KEVIN L SKINNER DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-339-1609
Mailing Address - Street 1:701 N PRESTON RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-3763
Mailing Address - Country:US
Mailing Address - Phone:972-382-4466
Mailing Address - Fax:
Practice Address - Street 1:701 N PRESTON RD
Practice Address - Street 2:SUITE 330
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-3763
Practice Address - Country:US
Practice Address - Phone:972-382-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty