Provider Demographics
NPI:1114910270
Name:MAYSTROVICH, SCOTT P (DC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:P
Last Name:MAYSTROVICH
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 1:5625 N WALL ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6435
Mailing Address - Country:US
Mailing Address - Phone:509-482-1982
Mailing Address - Fax:509-482-1983
Practice Address - Street 1:5625 N WALL ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6435
Practice Address - Country:US
Practice Address - Phone:509-482-1982
Practice Address - Fax:509-482-1983
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000010147569OtherREGENCE OF IDAHO
WAP00021492OtherRAILROAD MEDICARE
WA0157424OtherLABOR & INDUSTRIES
WA2026813Medicaid
WA2433MAOtherASURIS
WAU92144Medicare UPIN
WAAB27141Medicare ID - Type Unspecified