Healthcare Provider Details

I. General information

NPI: 1114535531
Provider Name (Legal Business Name): DR. CARRIE SKONY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 OGDEN AVE STE 202
LISLE IL
60532-1694
US

IV. Provider business mailing address

3080 OGDEN AVE STE 202
LISLE IL
60532-1694
US

V. Phone/Fax

Practice location:
  • Phone: 630-290-5169
  • Fax:
Mailing address:
  • Phone: 630-593-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CARRIE SKONY
Title or Position: OWNER, CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 630-593-3436