Provider Demographics
NPI:1912092289
Name:MIRITELLO, SCOTT L (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:MIRITELLO
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 1:204 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6629
Mailing Address - Country:US
Mailing Address - Phone:480-962-0868
Mailing Address - Fax:480-962-7010
Practice Address - Street 1:204 N CENTER ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6629
Practice Address - Country:US
Practice Address - Phone:480-962-0868
Practice Address - Fax:480-962-7010
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT41962Medicare UPIN
AZ24808Medicare ID - Type Unspecified