Individual
DR. ETHAN LEE SKOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
4900 HIGHWAY 169 N STE 301, NEW HOPE, MN 55428-4019
(763) 496-7871
Mailing address
4900 HIGHWAY 169 N STE 301, NEW HOPE, MN 55428-4019
(763) 496-7871
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6473
MN
Other
Enumeration date
05/09/2018
Last updated
01/20/2020
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