Provider Demographics
NPI:1790704104
Name:VANINA, SCOTT DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DOUGLAS
Last Name:VANINA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:DOUGLAS
Other - Last Name:VANINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1800 E HIGH ST
Mailing Address - Street 2:SUTIE 375
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3239
Mailing Address - Country:US
Mailing Address - Phone:610-970-5454
Mailing Address - Fax:610-970-5477
Practice Address - Street 1:1800 E HIGH ST
Practice Address - Street 2:SUTIE 375
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3239
Practice Address - Country:US
Practice Address - Phone:610-970-5454
Practice Address - Fax:610-970-5477
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4472111N00000X
PADC010785111N00000X
MN4277111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN120187500Medicaid
MN120187500Medicaid
PA361459UHYMedicare PIN
MN350003033Medicare ID - Type Unspecified