Provider Demographics
NPI:1740672187
Name:SCOTT J SCAFIDI DC PA
Entity type:Organization
Organization Name:SCOTT J SCAFIDI DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCAFIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-272-1992
Mailing Address - Street 1:404 GEORGE BISHOP PKWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-7338
Mailing Address - Country:US
Mailing Address - Phone:843-903-4508
Mailing Address - Fax:843-903-4509
Practice Address - Street 1:404 GEORGE BISHOP PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-7338
Practice Address - Country:US
Practice Address - Phone:843-903-4508
Practice Address - Fax:843-903-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty