Provider Demographics
NPI:1174669725
Name:SCOTT J. SCAFIDI DC PA
Entity Type:Organization
Organization Name:SCOTT J. SCAFIDI DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCAFIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-272-1992
Mailing Address - Street 1:1451 HIGHWAY 17 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3803
Mailing Address - Country:US
Mailing Address - Phone:843-272-1992
Mailing Address - Fax:843-272-1117
Practice Address - Street 1:1451 HIGHWAY 17 S
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3803
Practice Address - Country:US
Practice Address - Phone:843-272-1992
Practice Address - Fax:843-272-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH250Medicaid