Provider Demographics
NPI:1700809423
Name:SKADSEM, SARA BETH (DC)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:BETH
Last Name:SKADSEM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3926
Mailing Address - Country:US
Mailing Address - Phone:218-847-9235
Mailing Address - Fax:218-847-9236
Practice Address - Street 1:1225 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3926
Practice Address - Country:US
Practice Address - Phone:218-847-9235
Practice Address - Fax:218-847-9236
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor