Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2175 | MN |
NPI | 1013008762 |
---|---|
Provider Name | William Henry Skon |
First Address | Saint Paul, MN 55104-6304 |
Second Address | Saint Paul, MN 55104-6304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 21/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
066910000 | (05) | MN |
DP2418 | RAILROAD MEDICARE PTAN (01) | MN |