Provider Demographics
NPI:1366502221
Name:REDFERN, SCOTT S (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:S
Last Name:REDFERN
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 1:2145 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:STE 5
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7020
Mailing Address - Country:US
Mailing Address - Phone:760-327-2217
Mailing Address - Fax:760-327-2245
Practice Address - Street 1:2145 E TAHQUITZ CANYON WAY
Practice Address - Street 2:STE 5
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7020
Practice Address - Country:US
Practice Address - Phone:760-327-2217
Practice Address - Fax:760-327-2245
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARE5203OtherREGION'S RIDER
GAB16567Medicare ID - Type Unspecified