Provider Demographics
NPI:1619074127
Name:MILLISON, SCOTT LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LOUIS
Last Name:MILLISON
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 1:10153 YORK ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030
Mailing Address - Country:US
Mailing Address - Phone:410-628-2808
Mailing Address - Fax:410-628-2818
Practice Address - Street 1:10153 YORK ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030
Practice Address - Country:US
Practice Address - Phone:410-628-2808
Practice Address - Fax:410-628-2818
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT59587Medicare UPIN