Provider Demographics
NPI:1174551238
Name:SCOTT C HALE DOCTOR OF CHIROPRACTICS A PROFESSIONAL CORP
Entity type:Organization
Organization Name:SCOTT C HALE DOCTOR OF CHIROPRACTICS A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, QME
Authorized Official - Phone:530-622-3600
Mailing Address - Street 1:6390 RUNNYMEADE DR STE B
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8634
Mailing Address - Country:US
Mailing Address - Phone:530-622-3600
Mailing Address - Fax:530-622-3865
Practice Address - Street 1:6390 RUNNYMEADE DR STE B
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8634
Practice Address - Country:US
Practice Address - Phone:530-622-3600
Practice Address - Fax:530-622-3865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0166810111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0166810OtherCHIROPRACTIC LICENCE #
CAT06234Medicare UPIN