Provider Demographics
NPI:1285703090
Name:WIENER, SCOTT IVAN (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:IVAN
Last Name:WIENER
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 1:23360 VALENCIA BLVD STE R
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1749
Mailing Address - Country:US
Mailing Address - Phone:661-253-0221
Mailing Address - Fax:661-253-0814
Practice Address - Street 1:23360 VALENCIA BLVD STE R
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1749
Practice Address - Country:US
Practice Address - Phone:661-253-0221
Practice Address - Fax:661-253-0814
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor