Provider Demographics
NPI:1558359455
Name:NEWCOMER, SCOTT DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVID
Last Name:NEWCOMER
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 1:4811 S 76TH ST
Mailing Address - Street 2:STE 204
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4364
Mailing Address - Country:US
Mailing Address - Phone:414-281-5266
Mailing Address - Fax:414-281-9772
Practice Address - Street 1:4811 S 76TH ST
Practice Address - Street 2:STE 204
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4364
Practice Address - Country:US
Practice Address - Phone:414-281-5266
Practice Address - Fax:414-281-9772
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2260012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70545Medicare ID - Type Unspecified
T62870Medicare UPIN