Healthcare Provider Details

I. General information

NPI: 1467662742
Provider Name (Legal Business Name): SKON CHIROPRACTIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 RAYMOND AVE UNIT C
SAINT PAUL MN
55114
US

IV. Provider business mailing address

856 RAYMOND AVE UNIT C
SAINT PAUL MN
55114
US

V. Phone/Fax

Practice location:
  • Phone: 651-644-3900
  • Fax: 651-644-8969
Mailing address:
  • Phone: 651-644-3900
  • Fax: 651-644-8969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2175
License Number StateMN

VIII. Authorized Official

Name: DR. WILLIAM HENRY SKON
Title or Position: PRESIDENT
Credential: D.C.
Phone: 651-644-3900