Provider Demographics
NPI:1265505440
Name:SCOTT, ROBERT CAMPBELL (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CAMPBELL
Last Name:SCOTT
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 1:4180 NORTH RFD 83
Mailing Address - Street 2:SUITE100
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047
Mailing Address - Country:US
Mailing Address - Phone:847-821-3700
Mailing Address - Fax:
Practice Address - Street 1:4180 NORTH ROUTE 83
Practice Address - Street 2:SUITE100
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:847-821-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007631111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL421850Medicare ID - Type Unspecified
ILU69542Medicare UPIN