Provider Demographics
NPI:1942217534
Name:CATER, SCOTT ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:CATER
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 1:3913 PEPPER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-7281
Mailing Address - Country:US
Mailing Address - Phone:815-654-3577
Mailing Address - Fax:
Practice Address - Street 1:461 N MULFORD RD STE 3
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5165
Practice Address - Country:US
Practice Address - Phone:815-227-1600
Practice Address - Fax:815-227-1671
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10132105OtherBLUE CROSS & BLUE SHIELD
IL209043Medicare ID - Type Unspecified
IL10132105OtherBLUE CROSS & BLUE SHIELD