Provider Demographics
NPI:1558362160
Name:ROTHMAN, SCOTT BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BRUCE
Last Name:ROTHMAN
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 1:228 W WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3922
Mailing Address - Country:US
Mailing Address - Phone:610-688-2860
Mailing Address - Fax:
Practice Address - Street 1:228 W WAYNE AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3922
Practice Address - Country:US
Practice Address - Phone:610-688-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2008-06-06
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
PADC002806L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA131925OtherBLUE CROSS BLUE SHIELD NU