Provider Demographics
NPI:1811981277
Name:WARREN, SCOTT TYLER (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:TYLER
Last Name:WARREN
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 1:1650 LEAD HILL BLVD
Mailing Address - Street 2:# 600
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3061
Mailing Address - Country:US
Mailing Address - Phone:916-784-2454
Mailing Address - Fax:916-784-0454
Practice Address - Street 1:1650 LEAD HILL BLVD
Practice Address - Street 2:# 600
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3061
Practice Address - Country:US
Practice Address - Phone:916-784-2454
Practice Address - Fax:916-784-0454
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0265931Medicare ID - Type Unspecified
U97991Medicare UPIN