Provider Demographics
NPI:1477619427
Name:SHERIDAN, SCOTT ALLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLAN
Last Name:SHERIDAN
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 1:9925 214TH AVE E STE C
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-3910
Mailing Address - Country:US
Mailing Address - Phone:253-862-6662
Mailing Address - Fax:253-862-5553
Practice Address - Street 1:9925 214TH AVE E STE C
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-3910
Practice Address - Country:US
Practice Address - Phone:253-862-6662
Practice Address - Fax:253-862-5553
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU86635Medicare UPIN
8858516Medicare ID - Type Unspecified