Provider Demographics
NPI:1386773992
Name:KOCIS, SCOT DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:SCOT
Middle Name:DAVID
Last Name:KOCIS
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 1:5930 HAMILTON BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9654
Mailing Address - Country:US
Mailing Address - Phone:610-965-1414
Mailing Address - Fax:610-421-8821
Practice Address - Street 1:5930 HAMILTON BLVD
Practice Address - Street 2:STE 104
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9654
Practice Address - Country:US
Practice Address - Phone:610-965-1414
Practice Address - Fax:610-421-8821
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007654-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU80944Medicare UPIN
PA039362Medicare ID - Type Unspecified