Provider Demographics
NPI:1720157894
Name:SCOGGIN, SHAWN PHILLIP (DC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:PHILLIP
Last Name:SCOGGIN
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 1:5850 TOWN AND COUNTRY BLVD STE 701
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6958
Mailing Address - Country:US
Mailing Address - Phone:214-705-6100
Mailing Address - Fax:
Practice Address - Street 1:5850 TOWN AND COUNTRY BLVD STE 701
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6958
Practice Address - Country:US
Practice Address - Phone:214-705-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX10442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CE905OtherBCBS