Provider Demographics
NPI:1346444080
Name:SCOTT, BRYAN JACK (DC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:JACK
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 1:2787 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3719
Mailing Address - Country:US
Mailing Address - Phone:503-557-9929
Mailing Address - Fax:503-722-8218
Practice Address - Street 1:2787 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3719
Practice Address - Country:US
Practice Address - Phone:503-557-9929
Practice Address - Fax:503-722-8218
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGBBHMedicare ID - Type Unspecified