Provider Demographics
NPI:1093842155
Name:SCOTT, STACY (DC)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 TIMBER SHADOWS #101
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339
Mailing Address - Country:US
Mailing Address - Phone:281-359-1031
Mailing Address - Fax:281-359-1029
Practice Address - Street 1:2316 TIMBER SHADOWS #101
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-359-1031
Practice Address - Fax:281-359-1029
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603683OtherBLUE CROSS BLUE SHIELD
U35201Medicare UPIN
TX603683OtherBLUE CROSS BLUE SHIELD