Provider Demographics
NPI:1831100858
Name:SHALES, SCOTT PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:PATRICK
Last Name:SHALES
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 1:7626 WHISPERS LN
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9388
Mailing Address - Country:US
Mailing Address - Phone:315-524-3423
Mailing Address - Fax:
Practice Address - Street 1:853 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2550
Practice Address - Country:US
Practice Address - Phone:585-671-9210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010098-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC9386Medicare ID - Type Unspecified