Provider Demographics
NPI:1215091202
Name:LAMPSHIRE, SCOTT WARREN (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WARREN
Last Name:LAMPSHIRE
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 1:725 6TH AVE E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5005
Mailing Address - Country:US
Mailing Address - Phone:406-257-7572
Mailing Address - Fax:
Practice Address - Street 1:725 6TH AVE E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5005
Practice Address - Country:US
Practice Address - Phone:406-257-7572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTQMB0164509Medicaid
MTQMB0164509Medicaid