Provider Demographics
NPI:1326257718
Name:THURSTON, SCOTT PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:PATRICK
Last Name:THURSTON
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 1:3925 W HWY 30 A
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459
Mailing Address - Country:US
Mailing Address - Phone:850-622-2313
Mailing Address - Fax:850-622-2718
Practice Address - Street 1:3925 W HWY 30 A
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459
Practice Address - Country:US
Practice Address - Phone:850-622-2313
Practice Address - Fax:850-622-2718
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U93052Medicare UPIN
76945Medicare ID - Type Unspecified