Provider Demographics
NPI:1992877195
Name:SKOGSTAD, CHAD JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:JAMES
Last Name:SKOGSTAD
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 1:4606 COMMERCE VALLEY RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7074
Mailing Address - Country:US
Mailing Address - Phone:715-832-6616
Mailing Address - Fax:715-832-6454
Practice Address - Street 1:4606 COMMERCE VALLEY RD
Practice Address - Street 2:SUITE 209
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7074
Practice Address - Country:US
Practice Address - Phone:715-832-6616
Practice Address - Fax:715-832-6454
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3346-012111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38892500Medicaid
WI38892500Medicaid
WIU60774Medicare UPIN