Provider Demographics
NPI:1568503571
Name:HASTY, SCOTT KIEFER (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:KIEFER
Last Name:HASTY
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 1:7333 ROCKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3069
Mailing Address - Country:US
Mailing Address - Phone:317-273-4357
Mailing Address - Fax:
Practice Address - Street 1:7333 ROCKVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3069
Practice Address - Country:US
Practice Address - Phone:317-273-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100176910AMedicaid
IN523630AMedicare PIN