Provider Demographics
NPI:1114013828
Name:SCOTT, DYER LEROY
Entity Type:Individual
Prefix:DR
First Name:DYER
Middle Name:LEROY
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DYER
Other - Middle Name:LEROY
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1114 EAST CHIPPEWA STREET
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-772-4269
Mailing Address - Fax:989-773-9632
Practice Address - Street 1:1114 EAST CHIPPEWA STREET
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-772-4269
Practice Address - Fax:989-773-9632
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor