Provider Demographics
NPI:1235227364
Name:METTHAM, JOHN SCOTT (DC, PT)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCOTT
Last Name:METTHAM
Suffix:
Gender:M
Credentials:DC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16515 S 40TH ST STE 129
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0560
Mailing Address - Country:US
Mailing Address - Phone:480-940-7444
Mailing Address - Fax:480-940-7454
Practice Address - Street 1:16515 S 40TH ST STE 129
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0560
Practice Address - Country:US
Practice Address - Phone:480-940-7444
Practice Address - Fax:480-940-7454
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3751225100000X
AZ7077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU73212Medicare ID - Type Unspecified
AZ65496Medicare ID - Type UnspecifiedGROUP
AZ65585Medicare ID - Type UnspecifiedINDIVIDAUL