Provider Demographics
NPI:1740535681
Name:SCSM, INC
Entity type:Organization
Organization Name:SCSM, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-654-7400
Mailing Address - Street 1:4370 SE KING RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-1613
Mailing Address - Country:US
Mailing Address - Phone:503-654-7400
Mailing Address - Fax:503-654-1003
Practice Address - Street 1:4370 SE KING RD STE 220
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-1613
Practice Address - Country:US
Practice Address - Phone:503-654-7400
Practice Address - Fax:503-654-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500681331Medicaid