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General NPI Number Information
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NPI Number | 1881889574
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Entity Type | Organization
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Legal Business Name | SKDC INC.
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 04/30/2009
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Provider Practice Location Address
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Address Line | 2896 VIRGINIA AVE
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City | COLLINSVILLE
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State | VA
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Zip | 24078-2278
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Country | US
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Telephone | 276-647-9800
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Fax | 276-647-9818
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Provider Business Mailing Address
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Address Line | 2896 VIRGINIA AVE
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City | COLLINSVILLE
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State | VA
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Zip | 24078-2278
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Country | US
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Telephone | 276-647-9800
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Fax | 276-647-9818
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. STEPHEN PAUL KIESELBACH
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Credential | D.C.
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Telephone | 276-647-9800
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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 | 0104556547
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License Number State | VA
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