Provider Demographics
NPI:1659323400
Name:SCOTT, PAUL MONTGOMERY (DC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MONTGOMERY
Last Name:SCOTT
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 1:1905 SE 192ND AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7484
Mailing Address - Country:US
Mailing Address - Phone:360-844-5671
Mailing Address - Fax:360-954-5413
Practice Address - Street 1:1905 SE 192ND AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7484
Practice Address - Country:US
Practice Address - Phone:360-844-5671
Practice Address - Fax:360-954-5413
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002753111N00000X
CO5754111N00000X
OR272823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2014686Medicaid
U41203Medicare UPIN
WA2014686Medicaid