Provider Demographics
NPI:1811009384
Name:ESENBERG, SCOTT CHRISTIAN
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:CHRISTIAN
Last Name:ESENBERG
Suffix:
Gender:M
Credentials:
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 979
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-0979
Mailing Address - Country:US
Mailing Address - Phone:813-948-4440
Mailing Address - Fax:
Practice Address - Street 1:24426 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7303
Practice Address - Country:US
Practice Address - Phone:813-948-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380860200Medicaid
FLU56316Medicare UPIN
FL380860200Medicaid