Provider Demographics
NPI:1053510388
Name:SCOTT, PHILLIP WENDELL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:WENDELL
Last Name:SCOTT
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BUDDY
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:207 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-1303
Mailing Address - Country:US
Mailing Address - Phone:615-446-0999
Mailing Address - Fax:615-446-1842
Practice Address - Street 1:207 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1303
Practice Address - Country:US
Practice Address - Phone:615-446-0999
Practice Address - Fax:615-446-1842
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor