Provider Demographics
NPI:1780856989
Name:DOMINIQUE AND DONNA SCOTT CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DOMINIQUE AND DONNA SCOTT CHIROPRACTIC, INC.
Other - Org Name:LIFE CHIROPRACTIC OF THE SOUTH BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-546-5007
Mailing Address - Street 1:868 MANHATTAN BEACH BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4962
Mailing Address - Country:US
Mailing Address - Phone:310-546-5007
Mailing Address - Fax:
Practice Address - Street 1:868 MANHATTAN BEACH BLVD STE 1
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-4962
Practice Address - Country:US
Practice Address - Phone:310-546-5007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16809OtherMEDICARE GROUP NUMBER