Provider Demographics
NPI:1174508626
Name:ISON, SCOTTIE MITCHELL (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTTIE
Middle Name:MITCHELL
Last Name:ISON
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 1:3740 CLEVELAND HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813
Mailing Address - Country:US
Mailing Address - Phone:863-646-5707
Mailing Address - Fax:863-647-5044
Practice Address - Street 1:3740 CLEVELAND HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1215
Practice Address - Country:US
Practice Address - Phone:863-646-5707
Practice Address - Fax:863-647-5044
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLCH3418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050153100Medicaid
FL88583Medicare PIN
FL050153100Medicaid