Provider Demographics
NPI:1225005036
Name:SUTTON, SCOTT M (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:SUTTON
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 1:111 CANASAWACTA ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1311
Mailing Address - Country:US
Mailing Address - Phone:607-336-1500
Mailing Address - Fax:
Practice Address - Street 1:111 CANASAWACTA ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1311
Practice Address - Country:US
Practice Address - Phone:607-336-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008540-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1601237Medicaid
MA1601237Medicaid
NYU67986Medicare UPIN