Provider Demographics
NPI:1689686867
Name:ROSENTHAL, SCOTT EVAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EVAN
Last Name:ROSENTHAL
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 1:507 S MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-1611
Mailing Address - Country:US
Mailing Address - Phone:302-999-0633
Mailing Address - Fax:302-999-9826
Practice Address - Street 1:507 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-1611
Practice Address - Country:US
Practice Address - Phone:302-999-0633
Practice Address - Fax:302-999-9826
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000353111N00000X
PADC005385L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE771049Medicare ID - Type Unspecified
DEU51268Medicare UPIN