Healthcare Provider Details

I. General information

NPI: 1275677122
Provider Name (Legal Business Name): SKOCIK CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5431 JONESTOWN RD
HARRISBURG PA
17112-4062
US

IV. Provider business mailing address

5431 JONESTOWN RD
HARRISBURG PA
17112-4062
US

V. Phone/Fax

Practice location:
  • Phone: 717-540-8448
  • Fax: 717-540-6233
Mailing address:
  • Phone: 717-540-8448
  • Fax: 717-540-6233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberDC 003615 L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC 003615 L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 003615 L
License Number StatePA

VIII. Authorized Official

Name: DR. ALBERT JOSEPH SKOCIK
Title or Position: OWNER
Credential: D.C.
Phone: 717-540-8448