Provider Demographics
NPI:1932317690
Name:SCUDDER, SCOTT JONATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JONATHAN
Last Name:SCUDDER
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 1:2 NORTHUMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:EASTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-3212
Mailing Address - Country:US
Mailing Address - Phone:609-267-8040
Mailing Address - Fax:609-914-0231
Practice Address - Street 1:2 NORTHUMBERLAND DR
Practice Address - Street 2:
Practice Address - City:EASTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-3212
Practice Address - Country:US
Practice Address - Phone:609-267-8040
Practice Address - Fax:609-914-0231
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00439400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5005557OtherAETNA
NJU35553Medicare UPIN