Provider Demographics
NPI:1609818517
Name:SCOTT, JANE R (DC, DACNB)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:R
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 FOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2919
Mailing Address - Country:US
Mailing Address - Phone:770-972-9160
Mailing Address - Fax:770-978-1699
Practice Address - Street 1:2200 FOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2919
Practice Address - Country:US
Practice Address - Phone:770-972-9160
Practice Address - Fax:770-978-1699
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR02770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBGWMedicare ID - Type Unspecified
GAU41750Medicare UPIN