Provider Demographics
NPI:1346370947
Name:FORD, SCOTT DWIGHT (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DWIGHT
Last Name:FORD
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 1:210 WEST ST.
Mailing Address - Street 2:
Mailing Address - City:TONGANOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:66086
Mailing Address - Country:US
Mailing Address - Phone:913-845-9646
Mailing Address - Fax:913-369-9646
Practice Address - Street 1:210 WEST ST
Practice Address - Street 2:
Practice Address - City:TONGANOXIE
Practice Address - State:KS
Practice Address - Zip Code:66086-8927
Practice Address - Country:US
Practice Address - Phone:913-845-9646
Practice Address - Fax:913-369-9646
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014620Medicare PIN