Provider Demographics
NPI:1710160510
Name:DEVEREUX, SCOTT L (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:DEVEREUX
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 1:4500 TELEGRAPH RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-3399
Mailing Address - Country:US
Mailing Address - Phone:314-894-1842
Mailing Address - Fax:
Practice Address - Street 1:4500 TELEGRAPH RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3399
Practice Address - Country:US
Practice Address - Phone:314-894-1842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU81230Medicare UPIN