Provider Demographics
NPI:1306916473
Name:MACADAM, SCOTT NELSON (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:NELSON
Last Name:MACADAM
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 1:1731 SANTA ANA AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3141
Mailing Address - Country:US
Mailing Address - Phone:949-574-7700
Mailing Address - Fax:949-574-7780
Practice Address - Street 1:1731 SANTA ANA AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3141
Practice Address - Country:US
Practice Address - Phone:949-574-7700
Practice Address - Fax:949-574-7780
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20856111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44899Medicare UPIN