Provider Demographics
NPI:1710919576
Name:SARDONICUS, SCOTT SARAMA (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:SARAMA
Last Name:SARDONICUS
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 1:126 MAST RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4427
Mailing Address - Country:US
Mailing Address - Phone:603-842-4769
Mailing Address - Fax:
Practice Address - Street 1:126 MAST RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4427
Practice Address - Country:US
Practice Address - Phone:603-842-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH160-1193R111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0097712OtherCIGNA
NH0503117Y0NH01OtherANTHEM
NHRE5279Medicare ID - Type Unspecified
NHT52480Medicare UPIN