Provider Demographics
NPI:1790789386
Name:ZYLSTRA, SCOTT V (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:V
Last Name:ZYLSTRA
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 1:11 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2939
Mailing Address - Country:US
Mailing Address - Phone:256-245-0404
Mailing Address - Fax:256-245-0404
Practice Address - Street 1:11 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2939
Practice Address - Country:US
Practice Address - Phone:256-245-0404
Practice Address - Fax:256-245-0404
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000072029Medicare ID - Type Unspecified
ALT92665Medicare UPIN