Provider Demographics
NPI:1114037785
Name:SKINNER, DEAN D (DC)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:D
Last Name:SKINNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 WALTON NICHOLSON PIKE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-7901
Mailing Address - Country:US
Mailing Address - Phone:859-363-1000
Mailing Address - Fax:859-363-0836
Practice Address - Street 1:1922 WALTON NICHOLSON PIKE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-7901
Practice Address - Country:US
Practice Address - Phone:859-363-1000
Practice Address - Fax:859-363-0836
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4327111N00000X
NYX010063-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001394Medicaid
KY85001394Medicaid
KY6092401Medicare PIN