Provider Demographics
NPI:1215098058
Name:SKRILL, RICHARD LAWRENCE (DC MS MAC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:SKRILL
Suffix:
Gender:M
Credentials:DC MS MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3984 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1461
Mailing Address - Country:US
Mailing Address - Phone:520-321-1171
Mailing Address - Fax:520-321-1183
Practice Address - Street 1:3984 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1461
Practice Address - Country:US
Practice Address - Phone:520-321-1171
Practice Address - Fax:520-321-1183
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4974111N00000X
AZ221171100000X
AZ2790174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0237150OtherBLUE CROSS
1Z2120OtherHEALTH NET
AZAZ0237150OtherBLUE CROSS
U32860Medicare UPIN