Provider Demographics
NPI:1609074095
Name:MINTZ, SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:MINTZ
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 1:6442 COLDWATER CANYON AVE
Mailing Address - Street 2:#115
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1137
Mailing Address - Country:US
Mailing Address - Phone:818-321-5321
Mailing Address - Fax:818-478-3084
Practice Address - Street 1:6442 COLDWATER CANYON AVE
Practice Address - Street 2:#115
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1137
Practice Address - Country:US
Practice Address - Phone:818-321-5321
Practice Address - Fax:818-478-3084
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor