Provider Demographics
NPI:1487704466
Name:SKIDMORE, ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:SKIDMORE
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 1:1414 S FRIENDSWOOD DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4831
Mailing Address - Country:US
Mailing Address - Phone:281-482-5555
Mailing Address - Fax:281-756-0866
Practice Address - Street 1:1414 S FRIENDSWOOD DR
Practice Address - Street 2:SUITE 114
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4831
Practice Address - Country:US
Practice Address - Phone:281-482-5555
Practice Address - Fax:281-756-0866
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2010-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor