Provider Demographics
NPI:1942358619
Name:RUTH, SCOTT JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JOHN
Last Name:RUTH
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 1:636 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-1416
Mailing Address - Country:US
Mailing Address - Phone:215-295-9550
Mailing Address - Fax:215-295-9393
Practice Address - Street 1:636 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-1416
Practice Address - Country:US
Practice Address - Phone:215-295-9550
Practice Address - Fax:215-295-9393
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-0003555-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0109748000OtherBCBS PROV. ID
PA0310182000OtherBCBS GROUP #
PA232488352OtherTAX ID
PAU24835Medicare UPIN
PA232488352OtherTAX ID