Provider Demographics
NPI:1366637035
Name:TASCO, SCOT (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOT
Middle Name:
Last Name:TASCO
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 1:4497 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-1621
Mailing Address - Country:US
Mailing Address - Phone:248-608-2675
Mailing Address - Fax:
Practice Address - Street 1:4497 COLLINS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-1621
Practice Address - Country:US
Practice Address - Phone:248-608-2675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F338340OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI260454994OtherCOMMERCIAL
MI950F338340OtherBLUE CROSS BLUE SHIELD OF MICHIGAN