Provider Demographics
NPI:1174654313
Name:MASSENGILL, SCOTT ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALEXANDER
Last Name:MASSENGILL
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:PO BOX 1056
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-1056
Mailing Address - Country:US
Mailing Address - Phone:425-888-4170
Mailing Address - Fax:425-888-6431
Practice Address - Street 1:249 MAIN AVE. S.
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045
Practice Address - Country:US
Practice Address - Phone:425-888-4170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA35212OtherWA L & I
WA2016434Medicaid
WAMA0481OtherREGENCE
WA2016434Medicaid