Healthcare Provider Details

I. General information

NPI: 1114037785
Provider Name (Legal Business Name): DEAN D SKINNER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 WALTON NICHOLSON PIKE
INDEPENDENCE KY
41051-7901
US

IV. Provider business mailing address

1922 WALTON NICHOLSON PIKE
INDEPENDENCE KY
41051-7901
US

V. Phone/Fax

Practice location:
  • Phone: 859-363-1000
  • Fax: 859-363-0836
Mailing address:
  • Phone: 859-363-1000
  • Fax: 859-363-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4327
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX010063-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: