Provider Demographics
NPI:1366441453
Name:ULREY, SCOTT M (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:ULREY
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 1:303 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-4405
Mailing Address - Country:US
Mailing Address - Phone:920-261-0855
Mailing Address - Fax:920-261-0940
Practice Address - Street 1:303 S 1ST ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-4405
Practice Address - Country:US
Practice Address - Phone:920-261-0855
Practice Address - Fax:920-261-0940
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38760900Medicaid
WI391388868013OtherBLUE CROSS