Healthcare Provider Details

I. General information

NPI: 1144725979
Provider Name (Legal Business Name): SKINNER WELLNESS CENTER PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3198 CUSTER DR # 100
LEXINGTON KY
40517-4000
US

IV. Provider business mailing address

3198 CUSTER DR # 100
LEXINGTON KY
40517-4000
US

V. Phone/Fax

Practice location:
  • Phone: 859-231-6996
  • Fax: 859-255-4104
Mailing address:
  • Phone: 859-231-6996
  • Fax: 859-255-4104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRETT SKINNER
Title or Position: COMEMBER
Credential: DC
Phone: 859-396-3038