Provider Demographics
NPI:1356611636
Name:DR. RICHARD K. SKALA DC QME CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:DR. RICHARD K. SKALA DC QME CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SKALA
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:510-657-6366
Mailing Address - Street 1:43575 MISSION BLVD
Mailing Address - Street 2:#707
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5831
Mailing Address - Country:US
Mailing Address - Phone:510-657-6366
Mailing Address - Fax:510-657-3849
Practice Address - Street 1:5500 STEWART AVE
Practice Address - Street 2:#113
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-3100
Practice Address - Country:US
Practice Address - Phone:510-657-6366
Practice Address - Fax:510-657-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11658261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center