Provider Demographics
NPI:1306167358
Name:SCOTT, MATTHEW TODD (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TODD
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 1:1885 S WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1100
Mailing Address - Country:US
Mailing Address - Phone:408-370-2190
Mailing Address - Fax:408-379-0947
Practice Address - Street 1:1885 S WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1100
Practice Address - Country:US
Practice Address - Phone:408-370-2190
Practice Address - Fax:408-379-0947
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor