Provider Demographics
NPI:1265549620
Name:ISDALE, SKIP E (DC)
Entity type:Individual
Prefix:DR
First Name:SKIP
Middle Name:E
Last Name:ISDALE
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 1:2615 EXCHANGE PLACE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504
Mailing Address - Country:US
Mailing Address - Phone:254-778-0024
Mailing Address - Fax:254-774-7417
Practice Address - Street 1:2615 EXCHANGE PLACE
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-778-0024
Practice Address - Fax:254-774-7417
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600863Medicare UPIN
T14002Medicare UPIN