Provider Demographics
NPI:1669449468
Name:COON, SCOTT DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVID
Last Name:COON
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 1:465 W COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:E ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-2201
Mailing Address - Country:US
Mailing Address - Phone:585-425-9820
Mailing Address - Fax:
Practice Address - Street 1:465 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:E ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445
Practice Address - Country:US
Practice Address - Phone:585-425-9820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7792111N00000X
NY007792111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02117788Medicaid
NYU53467Medicare UPIN
NYCC1597Medicare ID - Type Unspecified