Provider Demographics
NPI:1265877492
Name:SCOTT, CARLYLE WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:CARLYLE
Middle Name:WILLIAM
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 1:2102 KOCH DR
Mailing Address - Street 2:302
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1247
Mailing Address - Country:US
Mailing Address - Phone:701-751-1660
Mailing Address - Fax:701-751-3717
Practice Address - Street 1:232 W FRONT AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504
Practice Address - Country:US
Practice Address - Phone:701-751-1660
Practice Address - Fax:701-751-3717
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor