Healthcare Provider Details

I. General information

NPI: 1366574824
Provider Name (Legal Business Name): WILLIAM D. SKELTON D.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SIMS AVE
COLUMBIA SC
29205-2618
US

IV. Provider business mailing address

620 SIMS AVE
COLUMBIA SC
29205-2618
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-1000
  • Fax:
Mailing address:
  • Phone: 803-256-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number00001
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: