Provider Demographics
NPI:1780668582
Name:SOUCIE, SCOTT CLIFFORD (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:CLIFFORD
Last Name:SOUCIE
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:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-0434
Mailing Address - Country:US
Mailing Address - Phone:970-568-9368
Mailing Address - Fax:
Practice Address - Street 1:4006 CLEVELAND AVE
Practice Address - Street 2:BUILDING B
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549
Practice Address - Country:US
Practice Address - Phone:970-568-9368
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor