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General NPI Number Information
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NPI Number | 1841366085
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Entity Type | Organization
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Legal Business Name | SKYLINE CHIROPRACTIC, P.A.
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 12940 HARRIET AVE S STE 240
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City | BURNSVILLE
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State | MN
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Zip | 55337-2680
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Country | US
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Telephone | 952-707-8588
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Fax | 952-707-8598
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Provider Business Mailing Address
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Address Line | 12940 HARRIET AVE S SUITE 240
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City | BURNSVILLE
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State | MN
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Zip | 55337-2680
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Country | US
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Telephone | 952-707-8588
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Fax | 952-707-8598
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID YEARLING
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Credential | D.C.
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Telephone | 952-707-8588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2462
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License Number State | MN
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