Provider Demographics
NPI:1578995817
Name:DOMINIQUE SCOTT CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DOMINIQUE SCOTT CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-546-5007
Mailing Address - Street 1:510 N PROSPECT AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3032
Mailing Address - Country:US
Mailing Address - Phone:310-376-5433
Mailing Address - Fax:
Practice Address - Street 1:510 N PROSPECT AVE STE 207
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3032
Practice Address - Country:US
Practice Address - Phone:310-376-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty