Provider Demographics
NPI:1417020389
Name:SEMLOW, SCOTT ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ROBERT
Last Name:SEMLOW
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 1:5353 GRAND HAVEN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441
Mailing Address - Country:US
Mailing Address - Phone:231-798-9355
Mailing Address - Fax:231-799-1777
Practice Address - Street 1:5353 GRAND HAVEN RD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441
Practice Address - Country:US
Practice Address - Phone:231-798-9355
Practice Address - Fax:231-799-1777
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4653981Medicaid
950F111190OtherBCBS
MI4653981Medicaid
MI0N94520Medicare ID - Type Unspecified