Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 3140 | WI |
NPI | 1053319004 |
---|---|
Provider Name | Dr. Wade David Skogman |
First Address | Seymour, WI 54165-8875 |
Second Address | Seymour, WI 54165-1475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 08/07/2007 |