Provider Demographics
NPI:1134200637
Name:SCOTT, JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:SCOTT
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 1:932 24TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-3915
Mailing Address - Country:US
Mailing Address - Phone:405-573-3700
Mailing Address - Fax:405-573-3255
Practice Address - Street 1:932 24TH AVE SW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3915
Practice Address - Country:US
Practice Address - Phone:405-573-3700
Practice Address - Fax:405-573-3700
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK238606601Medicare ID - Type Unspecified