Provider Demographics
NPI:1518971886
Name:FONDA, SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:FONDA
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 1:825 N CASS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1132
Mailing Address - Country:US
Mailing Address - Phone:630-522-4060
Mailing Address - Fax:630-522-4061
Practice Address - Street 1:825 N CASS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1132
Practice Address - Country:US
Practice Address - Phone:630-522-4060
Practice Address - Fax:630-522-4061
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007499111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038007499Medicaid
ILK10701Medicare PIN
IL038007499Medicaid
ILK10702Medicare PIN
U83136Medicare UPIN