Provider Demographics
NPI:1467504407
Name:BURTIS, SCOTT P (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:P
Last Name:BURTIS
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 1:112 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4058
Mailing Address - Country:US
Mailing Address - Phone:507-235-5551
Mailing Address - Fax:507-238-4429
Practice Address - Street 1:112 N STATE ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4058
Practice Address - Country:US
Practice Address - Phone:507-235-5551
Practice Address - Fax:507-238-4429
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN59662FAOtherINSURANCE ID
MN3D578BUOtherBLUE CROSS BLUE SHIELD
MN3D578BUOtherBLUE CROSS BLUE SHIELD