Provider Demographics
NPI:1649360140
Name:JEWKES, L SCOTT (DAC)
Entity type:Individual
Prefix:DR
First Name:L
Middle Name:SCOTT
Last Name:JEWKES
Suffix:
Gender:M
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 TUMBLEWEED WAY
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7682
Mailing Address - Country:US
Mailing Address - Phone:801-560-1748
Mailing Address - Fax:801-272-4260
Practice Address - Street 1:4578 HIGHLAND DR
Practice Address - Street 2:STE. 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4243
Practice Address - Country:US
Practice Address - Phone:801-272-4260
Practice Address - Fax:801-272-2827
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT100470-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist