Provider Demographics
NPI:1972661288
Name:PIDCOCK, SCOTT J (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
Last Name:PIDCOCK
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 1:3028 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-3505
Mailing Address - Country:US
Mailing Address - Phone:706-798-8980
Mailing Address - Fax:706-798-5650
Practice Address - Street 1:3028 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-3505
Practice Address - Country:US
Practice Address - Phone:706-798-8980
Practice Address - Fax:706-798-5650
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCDTQMedicare PIN
GAU66800Medicare UPIN