Provider Demographics
NPI:1437249448
Name:SIEGEL, SCOTT R (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:SIEGEL
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 1:12880 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1110
Mailing Address - Country:US
Mailing Address - Phone:734-246-8370
Mailing Address - Fax:
Practice Address - Street 1:12880 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1110
Practice Address - Country:US
Practice Address - Phone:734-246-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH25254Medicare ID - Type UnspecifiedPROVIDER NUMBER
MIT33746Medicare UPIN