Provider Demographics
NPI:1104936277
Name:SUTHERLAND, DEAN SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:SCOTT
Last Name:SUTHERLAND
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 1:4705 26TH ST W
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1704
Mailing Address - Country:US
Mailing Address - Phone:941-755-1581
Mailing Address - Fax:941-758-3577
Practice Address - Street 1:4705 26TH ST W
Practice Address - Street 2:SUITE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1704
Practice Address - Country:US
Practice Address - Phone:941-755-1581
Practice Address - Fax:941-758-3577
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55285OtherBLUE CROSS BLUE SHIELD
FL55285XOtherMEDICARE ID