Provider Demographics
NPI:1740415561
Name:ALBERT, SCOTT (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:ALBERT
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 1:718 GRISWOLD ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5847
Mailing Address - Country:US
Mailing Address - Phone:810-824-4995
Mailing Address - Fax:810-824-4998
Practice Address - Street 1:718 GRISWOLD ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5847
Practice Address - Country:US
Practice Address - Phone:810-824-4995
Practice Address - Fax:810-824-4998
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor