Provider Demographics
NPI:1386620524
Name:GOLDSMITH, SCOTT BRADY (DC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:BRADY
Last Name:GOLDSMITH
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 1:1480 HARRISBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2630
Mailing Address - Country:US
Mailing Address - Phone:717-291-1133
Mailing Address - Fax:717-291-1493
Practice Address - Street 1:1480 HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2630
Practice Address - Country:US
Practice Address - Phone:717-291-1133
Practice Address - Fax:717-291-1493
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA004695L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1433747OtherBS
PA02360600OtherBC
U10228Medicare UPIN
PA647415Medicare ID - Type Unspecified