Healthcare Provider Details

I. General information

NPI: 1346567260
Provider Name (Legal Business Name): SKK ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2010
Last Update Date: 05/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10165 HENNEPIN TOWN RD SUITE 103
EDEN PRAIRIE MN
55347-3104
US

IV. Provider business mailing address

10165 HENNEPIN TOWN RD SUITE 103
EDEN PRAIRIE MN
55347-3104
US

V. Phone/Fax

Practice location:
  • Phone: 952-405-6220
  • Fax:
Mailing address:
  • Phone: 952-405-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA0000
License Number StateMN

VIII. Authorized Official

Name: MR. MALCOLM BRUCE MCNEILL
Title or Position: PRESIDENT
Credential:
Phone: 952-212-4337