Provider Demographics
NPI:1740220904
Name:LENZ, SCOTT RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RICHARD
Last Name:LENZ
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 1:3030 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-1341
Mailing Address - Country:US
Mailing Address - Phone:541-826-6800
Mailing Address - Fax:541-826-7008
Practice Address - Street 1:3030 AVENUE H
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-1341
Practice Address - Country:US
Practice Address - Phone:541-826-6800
Practice Address - Fax:541-826-7008
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94348Medicare UPIN
130712Medicare ID - Type Unspecified