Provider Demographics
NPI:1831571793
Name:ALLEN, SCOTT BRADFORD (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:BRADFORD
Last Name:ALLEN
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 1:1140 CONNECTICUT AVE NW STE 950
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4031
Mailing Address - Country:US
Mailing Address - Phone:202-828-8303
Mailing Address - Fax:202-828-8305
Practice Address - Street 1:1140 CONNECTICUT AVE NW STE 950
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4031
Practice Address - Country:US
Practice Address - Phone:202-828-8303
Practice Address - Fax:202-828-8305
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00007192255A2300X
VA0104557570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104-557570OtherSTATE LICENSE