Provider Demographics
NPI:1881889574
Name:SKDC INC.
Entity type:Organization
Organization Name:SKDC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KIESELBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:276-647-9800
Mailing Address - Street 1:2896 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24078-2278
Mailing Address - Country:US
Mailing Address - Phone:276-647-9800
Mailing Address - Fax:276-647-9818
Practice Address - Street 1:2896 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24078-2278
Practice Address - Country:US
Practice Address - Phone:276-647-9800
Practice Address - Fax:276-647-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00X537S01Medicare PIN
VAC10323Medicare PIN