Provider Demographics
NPI:1073723706
Name:CORMIER, SCOTT (LAC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:CORMIER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 SAVANNAH HWY
Mailing Address - Street 2:UNIT A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7353
Mailing Address - Country:US
Mailing Address - Phone:843-640-1818
Mailing Address - Fax:
Practice Address - Street 1:513 SAVANNAH HWY
Practice Address - Street 2:UNIT A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7353
Practice Address - Country:US
Practice Address - Phone:843-640-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH078171100000X
SC165171100000X
ME247171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist