Healthcare Provider Details

I. General information

NPI: 1982749305
Provider Name (Legal Business Name): KEVIN JOHN SKOWRONEK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2728 NIAGARA FALLS BOULEVARD
NIAGARA FALLS NY
14304
US

IV. Provider business mailing address

2728 NIAGARA FALLS BOULEVARD
NIAGARA FALLS NY
14304
US

V. Phone/Fax

Practice location:
  • Phone: 716-695-2225
  • Fax: 716-695-1181
Mailing address:
  • Phone: 716-695-2225
  • Fax: 716-695-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX0097541
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: