Provider Demographics
NPI:1508838335
Name:FENWICK, SCOTT C (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:C
Last Name:FENWICK
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 1:1524 W GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4692
Mailing Address - Country:US
Mailing Address - Phone:309-692-6800
Mailing Address - Fax:309-692-4478
Practice Address - Street 1:1524 W GLEN AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4692
Practice Address - Country:US
Practice Address - Phone:309-692-6800
Practice Address - Fax:309-692-4478
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor