Provider Demographics
NPI:1710212220
Name:SHAWN SCOTT CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:SHAWN SCOTT CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEISKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-340-0100
Mailing Address - Street 1:72925 FRED WARING DR
Mailing Address - Street 2:STE. 204
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-9401
Mailing Address - Country:US
Mailing Address - Phone:760-340-0100
Mailing Address - Fax:760-340-1125
Practice Address - Street 1:72925 FRED WARING DR
Practice Address - Street 2:STE. 204
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9401
Practice Address - Country:US
Practice Address - Phone:760-340-0100
Practice Address - Fax:760-340-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19978261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0199780OtherMEDICARE PTAN