Provider Demographics
NPI:1063889145
Name:SIKORSKI, SCOTT A (LAC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:SIKORSKI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 BOHANNONS RD SE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-8081
Mailing Address - Country:US
Mailing Address - Phone:423-716-3324
Mailing Address - Fax:
Practice Address - Street 1:3575 ADKISSON DR NW STE 1040
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3087
Practice Address - Country:US
Practice Address - Phone:423-473-9313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3496171100000X
TN316171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist