Provider Demographics
NPI:1215682885
Name:SKY CHIROPRACTIC AND APPLIED KINESIOLOGY
Entity type:Organization
Organization Name:SKY CHIROPRACTIC AND APPLIED KINESIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-447-4473
Mailing Address - Street 1:104 BELLA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-9452
Mailing Address - Country:US
Mailing Address - Phone:570-447-4473
Mailing Address - Fax:
Practice Address - Street 1:911 WESTMINSTER DR STE 7
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3900
Practice Address - Country:US
Practice Address - Phone:570-447-4473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty