Provider Demographics
NPI:1326035866
Name:SCOTT, HARRY III (DO)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:
Last Name:SCOTT
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 N VAN BUREN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHIPSHEWANA
Mailing Address - State:IN
Mailing Address - Zip Code:46565-8702
Mailing Address - Country:US
Mailing Address - Phone:260-768-4324
Mailing Address - Fax:
Practice Address - Street 1:935 N VAN BUREN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SHIPSHEWANA
Practice Address - State:IN
Practice Address - Zip Code:46565-8702
Practice Address - Country:US
Practice Address - Phone:260-768-4061
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000842A111N00000X
MIL557686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000182245OtherBLUE CROSS
INT34843Medicare UPIN
IN000000182245OtherBLUE CROSS