Provider Demographics
NPI:1174674428
Name:KWARCIANY, SCOTT EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDWARD
Last Name:KWARCIANY
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 1:1122 LUDINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3540
Mailing Address - Country:US
Mailing Address - Phone:906-789-7950
Mailing Address - Fax:906-789-7951
Practice Address - Street 1:1122 LUDINGTON ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3540
Practice Address - Country:US
Practice Address - Phone:906-789-7950
Practice Address - Fax:906-789-7951
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU69280Medicare UPIN
MI0M59930Medicare ID - Type UnspecifiedMEDICARE