Provider Demographics
NPI:1952442881
Name:ELLIOTT, SCOTT RUSSELL (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:RUSSELL
Last Name:ELLIOTT
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 520
Mailing Address - Street 2:
Mailing Address - City:EVERSON
Mailing Address - State:WA
Mailing Address - Zip Code:98247-0520
Mailing Address - Country:US
Mailing Address - Phone:360-966-2700
Mailing Address - Fax:360-966-2701
Practice Address - Street 1:111 E MAIN ST.REET
Practice Address - Street 2:
Practice Address - City:EVERSON
Practice Address - State:WA
Practice Address - Zip Code:98247
Practice Address - Country:US
Practice Address - Phone:360-966-2700
Practice Address - Fax:360-966-2701
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0195OtherDEPT OF LABOR & INDUSRIES
WA2002442Medicaid
WA2002442Medicaid