Provider Demographics
NPI:1982777603
Name:ESPE, SCOTT W (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:ESPE
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 1:3722 WM PENN AVENUE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15909-4237
Mailing Address - Country:US
Mailing Address - Phone:814-749-0869
Mailing Address - Fax:814-749-0869
Practice Address - Street 1:3722 WM PENN AVENUE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15909-4237
Practice Address - Country:US
Practice Address - Phone:814-749-0869
Practice Address - Fax:814-749-0869
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002376 L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008754170002Medicaid
PA0008754170002Medicaid