Provider Demographics
NPI:1215904420
Name:SIEJA, SCOTT A (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:SIEJA
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:PO BOX 48413
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-0413
Mailing Address - Country:US
Mailing Address - Phone:817-595-9206
Mailing Address - Fax:817-595-9139
Practice Address - Street 1:6200 DENTON HWY
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-3023
Practice Address - Country:US
Practice Address - Phone:817-849-2395
Practice Address - Fax:817-849-2394
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7848268OtherAETNA
TX642008/2980599OtherACN
TX606293OtherBLUE CROSS BLUE SHIELD
TX642008OtherUNITED HEALTH CARE
TX1463804Medicaid
TX087276Medicare UPIN
TX606293OtherBLUE CROSS BLUE SHIELD