Provider Demographics
NPI:1871635581
Name:MEISEL, SCOTT A (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:MEISEL
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 1:514 GOULD ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-2433
Mailing Address - Country:US
Mailing Address - Phone:507-452-5142
Mailing Address - Fax:
Practice Address - Street 1:856 W 5TH ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5111
Practice Address - Country:US
Practice Address - Phone:507-452-5142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111228700Medicaid
MN111228700Medicaid
MN350001901Medicare ID - Type Unspecified