Provider Demographics
NPI:1922004688
Name:SCOTT, KEVIN TYLER (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:TYLER
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 1:2782 N HIGHLAND AVE
Mailing Address - Street 2:STE C
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1797
Mailing Address - Country:US
Mailing Address - Phone:731-664-5354
Mailing Address - Fax:731-664-5305
Practice Address - Street 1:2782 N HIGHLAND AVE
Practice Address - Street 2:STE C
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1797
Practice Address - Country:US
Practice Address - Phone:731-664-5354
Practice Address - Fax:731-664-5305
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5386529OtherAETNA
TN4021590OtherBLUE CROSS
TN3679657Medicaid
TN4021590OtherBLUE CROSS
TN3679657Medicaid