Provider Demographics
NPI:1518986173
Name:SCOTT, ROBERT JEFFERY (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JEFFERY
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 1:4260 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2937
Mailing Address - Country:US
Mailing Address - Phone:951-686-5040
Mailing Address - Fax:951-686-5049
Practice Address - Street 1:4260 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2937
Practice Address - Country:US
Practice Address - Phone:951-686-5040
Practice Address - Fax:951-686-5049
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAX70152Medicare UPIN
CAU85360Medicare UPIN
CAZZZ22861ZMedicare ID - Type Unspecified
CADC0261370Medicare ID - Type Unspecified