Provider Demographics
NPI:1093192296
Name:SCOTTIE M. ISON, DC
Entity Type:Organization
Organization Name:SCOTTIE M. ISON, DC
Other - Org Name:CLEVELAND HEIGHTS CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTTIE
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:ISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-646-5707
Mailing Address - Street 1:3740 CLEVELAND HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1215
Mailing Address - Country:US
Mailing Address - Phone:863-646-5707
Mailing Address - Fax:863-647-5044
Practice Address - Street 1:3740 CLEVELAND HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1215
Practice Address - Country:US
Practice Address - Phone:863-646-5707
Practice Address - Fax:863-647-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty