Provider Demographics
NPI:1750334033
Name:SYRACUSE, SCOTT ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLEN
Last Name:SYRACUSE
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 1:12364 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-9307
Mailing Address - Country:US
Mailing Address - Phone:716-542-3530
Mailing Address - Fax:716-542-3619
Practice Address - Street 1:12364 MAIN RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:NY
Practice Address - Zip Code:14001-9307
Practice Address - Country:US
Practice Address - Phone:716-542-3530
Practice Address - Fax:716-542-3619
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
286641Medicare PIN
NY286641Medicare PIN