Provider Demographics
NPI:1427365469
Name:NIMS, SCOTT L (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:L
Last Name:NIMS
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 1:232 MAIN ST NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1938
Mailing Address - Country:US
Mailing Address - Phone:815-939-4900
Mailing Address - Fax:815-939-4951
Practice Address - Street 1:232 MAIN ST NW
Practice Address - Street 2:SUITE 201
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1938
Practice Address - Country:US
Practice Address - Phone:815-939-4900
Practice Address - Fax:815-939-4951
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-011764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor