Provider Demographics
NPI:1710005160
Name:SCOTT CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:SCOTT CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:KWAPISZESKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-364-4060
Mailing Address - Street 1:135 N ROY HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GOODMAN
Mailing Address - State:MO
Mailing Address - Zip Code:64843-9806
Mailing Address - Country:US
Mailing Address - Phone:417-364-4060
Mailing Address - Fax:
Practice Address - Street 1:135 N ROY HILL BLVD
Practice Address - Street 2:
Practice Address - City:GOODMAN
Practice Address - State:MO
Practice Address - Zip Code:64843-9806
Practice Address - Country:US
Practice Address - Phone:417-364-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty