Provider Demographics
NPI:1942330360
Name:SCOTT, SHAWN RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:RAY
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:PO BOX 1231
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78639-1231
Mailing Address - Country:US
Mailing Address - Phone:325-388-2969
Mailing Address - Fax:325-388-2790
Practice Address - Street 1:1333 WEST HWY 1431
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:TX
Practice Address - Zip Code:78639
Practice Address - Country:US
Practice Address - Phone:325-388-2969
Practice Address - Fax:325-388-2790
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K9500OtherBCBS
TX8K9500OtherBCBS