Provider Demographics
NPI:1376602599
Name:SCOTT, DOUGLAS A (DC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
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 1:520 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-4017
Mailing Address - Country:US
Mailing Address - Phone:765-641-7700
Mailing Address - Fax:765-641-7016
Practice Address - Street 1:520 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-4017
Practice Address - Country:US
Practice Address - Phone:765-641-7700
Practice Address - Fax:765-641-7016
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001914A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200268550AMedicaid
IN200268550AMedicaid