Provider Demographics
NPI:1396856613
Name:BEAVERS, SCOTT DEAN (DC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DEAN
Last Name:BEAVERS
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 1:4700 ROCKLIN ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3334
Mailing Address - Country:US
Mailing Address - Phone:916-632-2676
Mailing Address - Fax:916-632-9869
Practice Address - Street 1:4700 ROCKLIN ROAD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3334
Practice Address - Country:US
Practice Address - Phone:916-632-2676
Practice Address - Fax:916-632-9869
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22963111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0229630Medicare ID - Type Unspecified
U42513Medicare UPIN