Provider Demographics
NPI:1154689933
Name:SCOTT FAMILY CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:SCOTT FAMILY CHIROPRACTIC CLINIC PC
Other - Org Name:SCOTT CHIROPRACTIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-821-3700
Mailing Address - Street 1:4180 RFD STE 83
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-9580
Mailing Address - Country:US
Mailing Address - Phone:847-821-3700
Mailing Address - Fax:847-821-7330
Practice Address - Street 1:4180 RFD STE 83
Practice Address - Street 2:SUITE 100
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-9580
Practice Address - Country:US
Practice Address - Phone:847-821-3700
Practice Address - Fax:847-821-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007631111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU69542Medicare UPIN
IL421850Medicare PIN