Provider Demographics
NPI:1922077874
Name:FLADLAND, SCOTT R (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:FLADLAND
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 1:17 N WABASH AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4717
Mailing Address - Country:US
Mailing Address - Phone:312-346-7313
Mailing Address - Fax:312-346-6530
Practice Address - Street 1:17 N WABASH AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4717
Practice Address - Country:US
Practice Address - Phone:312-346-7313
Practice Address - Fax:312-346-6530
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038005644Medicaid
IL01682740OtherBCBSIL
IL01682740OtherBCBSIL
ILK12529Medicare ID - Type Unspecified