Provider Demographics
NPI:1245730605
Name:COUNCILMAN, SCOTT CARLTON II
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:CARLTON
Last Name:COUNCILMAN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218C S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-2136
Mailing Address - Country:US
Mailing Address - Phone:919-356-5680
Mailing Address - Fax:
Practice Address - Street 1:8511 COLONNADE CENTER DR STE 132
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3067
Practice Address - Country:US
Practice Address - Phone:919-848-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor