Provider Demographics
NPI:1649418500
Name:SCORESBY, DEVIN P (DC)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:P
Last Name:SCORESBY
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 1:2677 E 17TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6613
Mailing Address - Country:US
Mailing Address - Phone:208-881-0686
Mailing Address - Fax:208-538-0034
Practice Address - Street 1:2677 E 17TH ST STE 500
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6613
Practice Address - Country:US
Practice Address - Phone:208-881-0686
Practice Address - Fax:208-538-0034
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1649418500Medicaid
ID1649418500Medicaid