Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1426 | MN |
NPI | 1003886078 |
---|---|
Provider Name | Gregory Skalko |
First Address | Chisholm, MN 55719-1732 |
Second Address | Chisholm, MN 55719-1732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 08/07/2007 |