Healthcare Provider Details

I. General information

NPI: 1992877195
Provider Name (Legal Business Name): CHAD JAMES SKOGSTAD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4606 COMMERCE VALLEY RD SUITE 209
EAU CLAIRE WI
54701-7074
US

IV. Provider business mailing address

4606 COMMERCE VALLEY RD SUITE 209
EAU CLAIRE WI
54701-7074
US

V. Phone/Fax

Practice location:
  • Phone: 715-832-6616
  • Fax: 715-832-6454
Mailing address:
  • Phone: 715-832-6616
  • Fax: 715-832-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3346-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: