Provider Demographics
NPI:1083920748
Name:DR SCOTTS CHIROPRACTIC SERVICES PC
Entity Type:Organization
Organization Name:DR SCOTTS CHIROPRACTIC SERVICES PC
Other - Org Name:VANDER WEIT CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANDER WEIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-658-8866
Mailing Address - Street 1:2407 W ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-9402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2407 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9402
Practice Address - Country:US
Practice Address - Phone:847-658-8866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty