Provider Demographics
NPI:1831129212
Name:URBAN, JOHN SCOTT III (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCOTT
Last Name:URBAN
Suffix:III
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:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45715-0235
Mailing Address - Country:US
Mailing Address - Phone:740-678-2700
Mailing Address - Fax:740-678-2777
Practice Address - Street 1:10595 STATE ROUTE 550
Practice Address - Street 2:
Practice Address - City:BARLOW
Practice Address - State:OH
Practice Address - Zip Code:45712
Practice Address - Country:US
Practice Address - Phone:740-678-2700
Practice Address - Fax:740-678-2777
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2289358Medicaid
OH31-1082707OtherTAX ID#
OHRE9320191Medicare ID - Type UnspecifiedGROUP PROVIDER
OH2289358Medicaid