Provider Demographics
NPI:1821068776
Name:HORTMAN, SCOTT ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:HORTMAN
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 1:15949 HWY 105 W
Mailing Address - Street 2:STE. 52 A
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5660
Mailing Address - Country:US
Mailing Address - Phone:936-588-5008
Mailing Address - Fax:936-588-1011
Practice Address - Street 1:15949 HWY 105 W
Practice Address - Street 2:STE 52 A
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5660
Practice Address - Country:US
Practice Address - Phone:936-588-5008
Practice Address - Fax:936-588-1011
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8830111N00000X
LA1237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15920602Medicaid
TX8W7960OtherBCBS
TXP00044424OtherRAIL ROAD MEDICARE
TX15920602Medicaid
TX8W7960OtherBCBS