Provider Demographics
NPI:1871179960
Name:SCROGGIN, KALEB RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KALEB
Middle Name:RYAN
Last Name:SCROGGIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5102 PAULSEN ST BLDG 7
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4624
Mailing Address - Country:US
Mailing Address - Phone:912-376-9191
Mailing Address - Fax:912-480-9553
Practice Address - Street 1:5102 PAULSEN ST BLDG 7
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4624
Practice Address - Country:US
Practice Address - Phone:912-376-9191
Practice Address - Fax:912-480-9553
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009817111N00000X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111N00000XChiropractic ProvidersChiropractor