Provider Demographics
NPI:1023151933
Name:TROMBONI, SCOTT W (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
Last Name:TROMBONI
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 1:8621 MARTIN WAY E
Mailing Address - Street 2:STE. 102
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5855
Mailing Address - Country:US
Mailing Address - Phone:360-456-4954
Mailing Address - Fax:360-412-1227
Practice Address - Street 1:8621 MARTIN WAY E
Practice Address - Street 2:STE. 102
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5855
Practice Address - Country:US
Practice Address - Phone:360-456-4954
Practice Address - Fax:360-412-1227
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU60892Medicare UPIN