Provider Demographics
NPI:1831310093
Name:MAIS, SCOTT ANTHONY (DC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ANTHONY
Last Name:MAIS
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:P.O. BOX 337
Mailing Address - Street 2:
Mailing Address - City:SCHOOLCRAFT
Mailing Address - State:MI
Mailing Address - Zip Code:49087
Mailing Address - Country:US
Mailing Address - Phone:269-679-5530
Mailing Address - Fax:269-679-5530
Practice Address - Street 1:115 SOUTH GRAND STREET
Practice Address - Street 2:
Practice Address - City:SCHOOLCRAFT
Practice Address - State:MI
Practice Address - Zip Code:49087
Practice Address - Country:US
Practice Address - Phone:269-679-5530
Practice Address - Fax:269-679-5530
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005565111N00000X
MI230100565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3222441Medicaid
MIU32337Medicare UPIN
0C95052Medicare PIN
MI3222441Medicaid