Provider Demographics
NPI:1720192982
Name:SCOTT, JOHN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:SCOTT
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 1:2603 S CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-3919
Mailing Address - Country:US
Mailing Address - Phone:817-560-1625
Mailing Address - Fax:817-560-1627
Practice Address - Street 1:2603 S CHERRY LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-3919
Practice Address - Country:US
Practice Address - Phone:817-560-1625
Practice Address - Fax:817-560-1627
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC3062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0014953-01Medicaid
TX416398Medicare UPIN
TX0014953-01Medicaid