Provider Demographics
NPI:1851346001
Name:STUCK, SCOTT DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVID
Last Name:STUCK
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 1:23915 W MAIN ST
Mailing Address - Street 2:UNIT 103
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-1967
Mailing Address - Country:US
Mailing Address - Phone:815-230-9070
Mailing Address - Fax:815-230-9334
Practice Address - Street 1:23915 W MAIN ST
Practice Address - Street 2:UNIT 103
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-1967
Practice Address - Country:US
Practice Address - Phone:815-230-9070
Practice Address - Fax:815-230-9334
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932028OtherBLUE CROSS BLUE SHIELD
IL9932028OtherBLUE CROSS BLUE SHIELD
IL212074Medicare ID - Type UnspecifiedMEDICARE GROUP #