Provider Demographics
NPI:1083619217
Name:SCOTT, MARK KEVIN (DC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:KEVIN
Last Name:SCOTT
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 1:1317 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2633
Mailing Address - Country:US
Mailing Address - Phone:606-329-9311
Mailing Address - Fax:606-324-9493
Practice Address - Street 1:1317 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2633
Practice Address - Country:US
Practice Address - Phone:606-329-9311
Practice Address - Fax:606-324-9493
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000248Medicaid
OH2206982Medicaid
KY85000248Medicaid
KY8845Medicare ID - Type Unspecified