Provider Demographics
NPI:1073532131
Name:UNGEMACH, SCOTT DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVID
Last Name:UNGEMACH
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 1:736 BALTIMORE PIKE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1074
Mailing Address - Country:US
Mailing Address - Phone:610-558-1001
Mailing Address - Fax:610-558-1180
Practice Address - Street 1:736 BALTIMORE PIKE
Practice Address - Street 2:SUITE 3
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1074
Practice Address - Country:US
Practice Address - Phone:610-558-1001
Practice Address - Fax:610-558-1180
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007620-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018040710001Medicaid
PA0018040710001Medicaid
033642NPDMedicare ID - Type Unspecified