Provider Demographics
NPI:1508923558
Name:ZAWADA, SCOTT EVERETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EVERETTE
Last Name:ZAWADA
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 1:1441 SECRET RAVINE PKWY
Mailing Address - Street 2:STE 140
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-6044
Mailing Address - Country:US
Mailing Address - Phone:916-773-0999
Mailing Address - Fax:916-773-9919
Practice Address - Street 1:1441 SECRET RAVINE PKWY
Practice Address - Street 2:STE 140
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6044
Practice Address - Country:US
Practice Address - Phone:916-773-0999
Practice Address - Fax:916-773-9919
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 27891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAB12470Medicare ID - Type Unspecified
CAU77772Medicare UPIN