Provider Demographics
NPI:1124126859
Name:MAWHINEY, SCOTT MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:MAWHINEY
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 1:224 N POINDEXTER ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4414
Mailing Address - Country:US
Mailing Address - Phone:252-335-7709
Mailing Address - Fax:252-331-7997
Practice Address - Street 1:224 N POINDEXTER ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4414
Practice Address - Country:US
Practice Address - Phone:252-335-7709
Practice Address - Fax:252-331-7997
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0833NOtherBC/BS NC
NC890833NMedicaid
NCU86488Medicare UPIN
NC2454215Medicare ID - Type Unspecified