Provider Demographics
NPI:1043626682
Name:SKINNER CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:SKINNER CHIROPRACTIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:682-203-8098
Mailing Address - Street 1:5400 E MOCKINGBIRD LN
Mailing Address - Street 2:SUITE 214
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-8904
Mailing Address - Country:US
Mailing Address - Phone:214-821-9999
Mailing Address - Fax:
Practice Address - Street 1:5400 E MOCKINGBIRD LN
Practice Address - Street 2:SUITE 214
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-8904
Practice Address - Country:US
Practice Address - Phone:214-821-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty