Provider Demographics
NPI:1760558183
Name:HEGSETH, SCOTT L (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:HEGSETH
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 1:11015 N DALE MABRY HWY STE B
Mailing Address - Street 2:STE B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3872
Mailing Address - Country:US
Mailing Address - Phone:813-269-2828
Mailing Address - Fax:
Practice Address - Street 1:11015 N DALE MABRY HWY STE B
Practice Address - Street 2:STE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3872
Practice Address - Country:US
Practice Address - Phone:813-269-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor