MEDICARE: KEVIN L SKINNER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	11416	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740244003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN L SKINNER DC

Provider Business Mailing Address
First Line	:	3312 HAMILTON DR
Second Line	:
City	:	MELISSA
State	:	TX
Zip	:	75454-2502
Country	:	US
Telephone Number	:	501-339-1609
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 N PRESTON RD STE 330
Second Line	:
City	:	CELINA
State	:	TX
Zip	:	75009-3812
Country	:	US
Telephone Number	:	501-339-1609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	07/01/2011

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