Provider Demographics
NPI:1952684078
Name:SCOTT SPINE AND THERAPY INC
Entity Type:Organization
Organization Name:SCOTT SPINE AND THERAPY INC
Other - Org Name:SUMMIT SPINE AND THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-284-1329
Mailing Address - Street 1:5750 E 91ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1380
Mailing Address - Country:US
Mailing Address - Phone:317-284-1329
Mailing Address - Fax:317-284-1346
Practice Address - Street 1:5750 E 91ST ST STE B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1380
Practice Address - Country:US
Practice Address - Phone:317-284-1329
Practice Address - Fax:317-284-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-25
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002298A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty