Provider Demographics
NPI:1699833483
Name:DOROSKI, SCOTT MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:DOROSKI
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 1:3122 GOLANSKY BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4267
Mailing Address - Country:US
Mailing Address - Phone:703-730-9588
Mailing Address - Fax:
Practice Address - Street 1:3122 GOLANSKY BLVD
Practice Address - Street 2:STE 102
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4267
Practice Address - Country:US
Practice Address - Phone:703-730-9588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001511111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU61328Medicare UPIN