Provider Demographics
NPI:1003103938
Name:CRUSE, SCOTT M (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:CRUSE
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 1:2625 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 301N
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1234
Mailing Address - Country:US
Mailing Address - Phone:630-468-1824
Mailing Address - Fax:630-701-1007
Practice Address - Street 1:2210 CAMDEN CT
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1272
Practice Address - Country:US
Practice Address - Phone:630-468-1820
Practice Address - Fax:630-468-1823
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-011574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor