Provider Demographics
NPI:1336259787
Name:CHAMBERLAIN, SCOTT GARRETT (DC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:GARRETT
Last Name:CHAMBERLAIN
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 1:2001 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662
Mailing Address - Country:US
Mailing Address - Phone:559-896-4944
Mailing Address - Fax:559-896-2390
Practice Address - Street 1:2001 FIRST STREET
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662
Practice Address - Country:US
Practice Address - Phone:559-896-4944
Practice Address - Fax:559-896-4944
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0205450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU56851Medicare UPIN