Provider Demographics
NPI:1104938810
Name:SCOTT, ANDREW R (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
Last Name:SCOTT
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 1:1271 PLEASANT GROVE BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-5882
Mailing Address - Country:US
Mailing Address - Phone:916-791-2010
Mailing Address - Fax:916-791-2070
Practice Address - Street 1:1271 PLEASANT GROVE BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-5882
Practice Address - Country:US
Practice Address - Phone:916-791-2010
Practice Address - Fax:916-791-2070
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0290030Medicaid
CAZZZ30551ZMedicare PIN
CADC0290030Medicaid