Provider Demographics
NPI:1376627695
Name:SCHUCK, SCOTT G (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:G
Last Name:SCHUCK
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 1:29 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4002
Mailing Address - Country:US
Mailing Address - Phone:405-340-3277
Mailing Address - Fax:405-604-3021
Practice Address - Street 1:8924 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9202
Practice Address - Country:US
Practice Address - Phone:405-602-8925
Practice Address - Fax:405-604-3021
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1304889718Medicaid
ARU49979Medicare UPIN
AR59968Medicare ID - Type Unspecified