Provider Demographics
NPI:1013017243
Name:POPP, SCOTT DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DEAN
Last Name:POPP
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 1:300 LANDMARK DR STE F
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4233
Mailing Address - Country:US
Mailing Address - Phone:307-266-0739
Mailing Address - Fax:307-237-3136
Practice Address - Street 1:300 LANDMARK DR STE F
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4233
Practice Address - Country:US
Practice Address - Phone:307-237-6669
Practice Address - Fax:307-237-3136
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY598111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYT31319Medicare UPIN