Provider Demographics
NPI:1659343655
Name:HARRIS, SCOTT WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WAYNE
Last Name:HARRIS
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 1:7207 265TH ST NW
Mailing Address - Street 2:STE 102
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292
Mailing Address - Country:US
Mailing Address - Phone:360-629-6544
Mailing Address - Fax:360-629-4520
Practice Address - Street 1:7207 265TH ST NW
Practice Address - Street 2:STE 102
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292
Practice Address - Country:US
Practice Address - Phone:360-629-6544
Practice Address - Fax:360-629-4520
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2013175Medicaid
T03099Medicare UPIN
WA2013175Medicaid