Provider Demographics
NPI:1366852014
Name:SCOTT CHIROPRACTIC AND WELLNESS
Entity Type:Organization
Organization Name:SCOTT CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-540-5445
Mailing Address - Street 1:5080 VIRGINIA PKWY STE 550
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5633
Mailing Address - Country:US
Mailing Address - Phone:972-540-5445
Mailing Address - Fax:972-540-5433
Practice Address - Street 1:5080 VIRGINIA PKWY
Practice Address - Street 2:STE 550
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5599
Practice Address - Country:US
Practice Address - Phone:972-540-5445
Practice Address - Fax:972-540-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-03
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty