Provider Demographics
NPI:1316315153
Name:SCOTT D. BAUTCH D C S C
Entity type:Organization
Organization Name:SCOTT D. BAUTCH D C S C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-842-3999
Mailing Address - Street 1:3540 STEWART AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4919
Mailing Address - Country:US
Mailing Address - Phone:715-842-3999
Mailing Address - Fax:715-843-7761
Practice Address - Street 1:3540 STEWART AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4919
Practice Address - Country:US
Practice Address - Phone:715-842-3999
Practice Address - Fax:715-843-7761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1892-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38786000Medicaid