Provider Demographics
NPI:1164141503
Name:SCOTT, RICHARD R JR (LAC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:R
Last Name:SCOTT
Suffix:JR
Gender:M
Credentials:LAC
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 175
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:WI
Mailing Address - Zip Code:54838-0175
Mailing Address - Country:US
Mailing Address - Phone:715-520-2466
Mailing Address - Fax:
Practice Address - Street 1:440 BUSINESS 53 STE C
Practice Address - Street 2:
Practice Address - City:MINONG
Practice Address - State:WI
Practice Address - Zip Code:54859-9550
Practice Address - Country:US
Practice Address - Phone:715-520-2466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1045-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1045-55OtherSTATE LICENSE