Provider Demographics
NPI:1649360694
Name:VINCI, SCOTT ANTHONY (DC, DACBSP)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANTHONY
Last Name:VINCI
Suffix:
Gender:M
Credentials:DC, DACBSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2803
Mailing Address - Country:US
Mailing Address - Phone:631-979-3613
Mailing Address - Fax:631-979-2847
Practice Address - Street 1:1308 TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2803
Practice Address - Country:US
Practice Address - Phone:631-979-3613
Practice Address - Fax:631-979-2847
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-004870-1111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX1D191Medicare UPIN