MEDICARE: DR. THOMAS RAYMOND SKELTON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104000609	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134129810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS RAYMOND SKELTON D.C.

Provider Business Mailing Address
First Line	:	1202 HARTFORD DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5844
Country	:	US
Telephone Number	:	757-343-6450
Fax Number	:

Provider Business Practice Location Address
First Line	:	4867 BAXTER RD
Second Line	:	SUITE 107
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4469
Country	:	US
Telephone Number	:	757-497-1555
Fax Number	:	757-497-2715

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	05/04/2022

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