Provider Demographics
NPI:1255347936
Name:WALDEIS, SCOTT P (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:P
Last Name:WALDEIS
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:PO BOX 220
Mailing Address - Street 2:130 SOUTH MAIN STREET
Mailing Address - City:NAPLES
Mailing Address - State:NY
Mailing Address - Zip Code:14512-0220
Mailing Address - Country:US
Mailing Address - Phone:585-374-2670
Mailing Address - Fax:585-374-2682
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:NY
Practice Address - Zip Code:14512-9293
Practice Address - Country:US
Practice Address - Phone:585-374-2670
Practice Address - Fax:585-374-2682
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008948-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU86901Medicare UPIN