Provider Demographics
NPI:1912184839
Name:LALLY, SCOTT A (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:LALLY
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 1:1508 S 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4859
Mailing Address - Country:US
Mailing Address - Phone:509-248-0301
Mailing Address - Fax:509-248-0337
Practice Address - Street 1:1508 S 36TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4859
Practice Address - Country:US
Practice Address - Phone:509-248-0301
Practice Address - Fax:509-248-0337
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor