Healthcare Provider Details

I. General information

NPI: 1538279070
Provider Name (Legal Business Name): PHILLIP M SKOW D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 10TH ST N
MOUNTAIN LAKE MN
56159-1591
US

IV. Provider business mailing address

PO BOX 317
MOUNTAIN LAKE MN
56159
US

V. Phone/Fax

Practice location:
  • Phone: 507-427-3878
  • Fax: 507-427-3531
Mailing address:
  • Phone: 507-427-3878
  • Fax: 507-427-3531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number002683
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: