Provider Demographics
NPI:1720165095
Name:MANCHESTER, SCOTT MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MARTIN
Last Name:MANCHESTER
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 1:3634 MCCAIN RD
Mailing Address - Street 2:UNIT 7
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-2576
Mailing Address - Country:US
Mailing Address - Phone:517-962-2178
Mailing Address - Fax:517-962-2399
Practice Address - Street 1:3634 MCCAIN RD
Practice Address - Street 2:UNIT 7
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-2576
Practice Address - Country:US
Practice Address - Phone:517-962-2178
Practice Address - Fax:517-962-2399
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U25909Medicare UPIN
MIMI6442001Medicare PIN