Provider Demographics
NPI:1235294026
Name:CAPESIUS, SCOTT A (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:CAPESIUS
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 1:850C LOMBARDI AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-3768
Mailing Address - Country:US
Mailing Address - Phone:920-430-7400
Mailing Address - Fax:920-430-7405
Practice Address - Street 1:850C LOMBARDI AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-3768
Practice Address - Country:US
Practice Address - Phone:920-430-7400
Practice Address - Fax:920-430-7405
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3491111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38908200Medicaid
WIU71390Medicare UPIN
WI000035412Medicare ID - Type Unspecified