Provider Demographics
NPI:1659572139
Name:HARDER, SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:HARDER
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 1:12841 NE 85TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8009
Mailing Address - Country:US
Mailing Address - Phone:425-893-9200
Mailing Address - Fax:425-893-8046
Practice Address - Street 1:12841 NE 85TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8009
Practice Address - Country:US
Practice Address - Phone:425-893-9200
Practice Address - Fax:425-893-8046
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0124693OtherDEPARTMENT OF L & I
WAGAB21967Medicare ID - Type Unspecified
WAU72342Medicare UPIN