Provider Demographics
NPI:1093868150
Name:VAUTRIN, SCOTT (DC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:VAUTRIN
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:PO BOX 910746
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-0746
Mailing Address - Country:US
Mailing Address - Phone:435-627-2112
Mailing Address - Fax:435-628-2845
Practice Address - Street 1:594 WEST 400 NORTH
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-627-2112
Practice Address - Fax:435-628-2845
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5230235-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT20-0623875OtherFEDERAL TAX I.D. NUMBER
UT000056368Medicare PIN