Provider Demographics
NPI:1265566855
Name:FLETCHER, SCOTT DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVID
Last Name:FLETCHER
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 1:5246 N EAGLE RD
Mailing Address - Street 2:STE 106
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-0945
Mailing Address - Country:US
Mailing Address - Phone:208-939-3000
Mailing Address - Fax:208-939-3030
Practice Address - Street 1:5246 N EAGLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0945
Practice Address - Country:US
Practice Address - Phone:208-939-3000
Practice Address - Fax:208-939-3030
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010028569OtherREGENCE BLUE SHIELD
IDC2573OtherBLUE CROSS
ID000010028569OtherREGENCE BLUE SHIELD
IDC2573OtherBLUE CROSS