Provider Demographics
NPI:1477952471
Name:SCOTT, MICHAEL DEWAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEWAYNE
Last Name:SCOTT
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 1:12462 CAMINITO BRIOSO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3560
Mailing Address - Country:US
Mailing Address - Phone:408-858-7438
Mailing Address - Fax:
Practice Address - Street 1:9450 MIRA MESA BLVD
Practice Address - Street 2:SUITE C #620
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4801
Practice Address - Country:US
Practice Address - Phone:888-590-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor