Provider Demographics
NPI:1538228457
Name:SKAGGS, JAMIE C (DC)
Entity type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:C
Last Name:SKAGGS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:C
Other - Last Name:SKAGGS
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:54 NORTH COUNTRY ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764
Mailing Address - Country:US
Mailing Address - Phone:631-331-2272
Mailing Address - Fax:631-331-4398
Practice Address - Street 1:54 NORTH COUNTRY ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764
Practice Address - Country:US
Practice Address - Phone:631-331-2272
Practice Address - Fax:631-331-4398
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0082131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
78136Medicare UPIN
NYX1C991Medicare ID - Type Unspecified