Provider Demographics
NPI:1740538453
Name:SCOTT JABLON DC, PA
Entity type:Organization
Organization Name:SCOTT JABLON DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:JABLON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-510-2225
Mailing Address - Street 1:8327 W ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7452
Mailing Address - Country:US
Mailing Address - Phone:954-510-2225
Mailing Address - Fax:954-510-2227
Practice Address - Street 1:8327 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7452
Practice Address - Country:US
Practice Address - Phone:954-510-2225
Practice Address - Fax:954-510-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4007261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70401Medicare UPIN
FLT84451Medicare UPIN