Provider Demographics
NPI:1467857037
Name:SCOTT, LARISA SUSAN (DC)
Entity Type:Individual
Prefix:DR
First Name:LARISA
Middle Name:SUSAN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LARISA
Other - Middle Name:SUSAN
Other - Last Name:TITERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1100 TOWN PLAZA CT
Mailing Address - Street 2:STE 1020
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-6231
Mailing Address - Country:US
Mailing Address - Phone:407-901-7704
Mailing Address - Fax:407-288-8582
Practice Address - Street 1:1100 TOWN PLAZA CT
Practice Address - Street 2:STE 1020
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6231
Practice Address - Country:US
Practice Address - Phone:407-901-7704
Practice Address - Fax:407-288-8582
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-25
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor