Provider Demographics
NPI:1740251438
Name:BRANTLEY, SCOTT ROGER (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ROGER
Last Name:BRANTLEY
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 1:1810 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-2524
Mailing Address - Country:US
Mailing Address - Phone:620-793-5588
Mailing Address - Fax:620-793-5589
Practice Address - Street 1:1810 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-2524
Practice Address - Country:US
Practice Address - Phone:620-793-5588
Practice Address - Fax:620-793-5589
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU38395Medicare UPIN
KS023795Medicare ID - Type UnspecifiedMEDICARE ID NUMBER