Provider Demographics
NPI:1376657999
Name:AUGHENBAUGH, SCOTT D (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:AUGHENBAUGH
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:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:EARLVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60518-0174
Mailing Address - Country:US
Mailing Address - Phone:815-246-8611
Mailing Address - Fax:815-246-8621
Practice Address - Street 1:139 W RAILROAD ST
Practice Address - Street 2:
Practice Address - City:EARLVILLE
Practice Address - State:IL
Practice Address - Zip Code:60518-3119
Practice Address - Country:US
Practice Address - Phone:815-246-8611
Practice Address - Fax:815-246-8621
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002222663OtherBC/BS
IL36-4246500OtherCORPORATE TAX ID
IL0002222663OtherBC/BS