Provider Demographics
NPI:1346312428
Name:SOLUK, SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:SOLUK
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 1:2812 SANTA MONICA BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2432
Mailing Address - Country:US
Mailing Address - Phone:760-436-7999
Mailing Address - Fax:760-436-3993
Practice Address - Street 1:2812 SANTA MONICA BLVD
Practice Address - Street 2:STE 208
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2432
Practice Address - Country:US
Practice Address - Phone:760-436-7999
Practice Address - Fax:760-436-3993
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU78875Medicare UPIN