Provider Demographics
NPI:1043259120
Name:SKINNER, KYLE L (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:L
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 1:103 PARK DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7407
Mailing Address - Country:US
Mailing Address - Phone:501-851-6685
Mailing Address - Fax:
Practice Address - Street 1:103 PARK DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7407
Practice Address - Country:US
Practice Address - Phone:501-851-6685
Practice Address - Fax:501-851-6495
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y803Medicare ID - Type Unspecified