Provider Demographics
NPI:1851702864
Name:SCOTT, WADE (DC)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:
Last Name:SCOTT
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 1:318 NORTHCREEK BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1934
Mailing Address - Country:US
Mailing Address - Phone:615-851-0515
Mailing Address - Fax:615-851-0537
Practice Address - Street 1:318 NORTHCREEK BLVD
Practice Address - Street 2:STE 300
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1934
Practice Address - Country:US
Practice Address - Phone:615-851-0515
Practice Address - Fax:615-851-0537
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor