Provider Demographics
NPI:1629108840
Name:SCOVILLE, J. STEWART (DC)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:STEWART
Last Name:SCOVILLE
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 1:150 S 700 E STE 1
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-3131
Mailing Address - Country:US
Mailing Address - Phone:435-637-4822
Mailing Address - Fax:435-637-4828
Practice Address - Street 1:150 S 700 E STE 1
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-3131
Practice Address - Country:US
Practice Address - Phone:435-637-4822
Practice Address - Fax:435-637-4828
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1754941202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT78102Medicare UPIN