Provider Demographics
NPI:1750311437
Name:NEELEY, SCOTT PETERSON (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:PETERSON
Last Name:NEELEY
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 1:11199 SORRENTO VALLEY RD
Mailing Address - Street 2:201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1334
Mailing Address - Country:US
Mailing Address - Phone:858-768-6111
Mailing Address - Fax:858-768-6116
Practice Address - Street 1:11199 SORRENTO VALLEY RD
Practice Address - Street 2:201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1334
Practice Address - Country:US
Practice Address - Phone:858-768-6111
Practice Address - Fax:858-768-6116
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU43411Medicare UPIN
CAWDC22098BMedicare ID - Type Unspecified