Provider Demographics
NPI:1043607252
Name:SCOTT, KRYSTLE (DC)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-2901
Mailing Address - Country:US
Mailing Address - Phone:609-261-7562
Mailing Address - Fax:
Practice Address - Street 1:227 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2901
Practice Address - Country:US
Practice Address - Phone:609-261-7562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-26
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00713500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor