Healthcare Provider Details

I. General information

NPI: 1720041643
Provider Name (Legal Business Name): ELIZABETH LYNN SKORUPA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11832 CANON BLVD STE E
NEWPORT NEWS VA
23606-2580
US

IV. Provider business mailing address

11832 CANON BLVD STE E
NEWPORT NEWS VA
23606-2580
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-7786
  • Fax: 757-598-5989
Mailing address:
  • Phone: 757-873-7786
  • Fax: 757-598-5989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01040001842
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: