Provider Demographics
NPI:1164796579
Name:SCOVELL, JOE RICHARD (DC)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:RICHARD
Last Name:SCOVELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:RICHARD
Other - Last Name:SCOVELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:DRESSER
Mailing Address - State:WI
Mailing Address - Zip Code:54009-0186
Mailing Address - Country:US
Mailing Address - Phone:715-755-2583
Mailing Address - Fax:715-755-2573
Practice Address - Street 1:115 N STATE HWY 35
Practice Address - Street 2:
Practice Address - City:DRESSER
Practice Address - State:WI
Practice Address - Zip Code:54009-0186
Practice Address - Country:US
Practice Address - Phone:715-755-2583
Practice Address - Fax:715-755-2573
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4832-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor