Provider Demographics
NPI:1396740007
Name:ROMESBURG, SCOTT K JR (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:K
Last Name:ROMESBURG
Suffix:JR
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 1:351 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1845
Mailing Address - Country:US
Mailing Address - Phone:304-842-6993
Mailing Address - Fax:304-842-4661
Practice Address - Street 1:351 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1845
Practice Address - Country:US
Practice Address - Phone:304-842-6993
Practice Address - Fax:304-842-4661
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVNO 9294701Medicare ID - Type Unspecified
WVT32326Medicare UPIN