Provider Demographics
NPI:1003103938
Name:CRUSE, SCOTT M (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:CRUSE
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 1:816 ASBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3114
Mailing Address - Country:US
Mailing Address - Phone:224-250-3526
Mailing Address - Fax:
Practice Address - Street 1:1400 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-1837
Practice Address - Country:US
Practice Address - Phone:847-496-4567
Practice Address - Fax:630-468-1823
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-011574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor