Provider Demographics
NPI:1578696696
Name:SCOTT, RAYMOND DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:DALE
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:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:PEARCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85625-0468
Mailing Address - Country:US
Mailing Address - Phone:520-826-1851
Mailing Address - Fax:
Practice Address - Street 1:1317 E JUSTIN ST
Practice Address - Street 2:
Practice Address - City:PEARCE
Practice Address - State:AZ
Practice Address - Zip Code:85625-4046
Practice Address - Country:US
Practice Address - Phone:520-826-1851
Practice Address - Fax:520-826-0258
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor