Provider Demographics
NPI:1487878195
Name:SCOTT, JACK DWYER (DC)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:DWYER
Last Name:SCOTT
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 1:4016 RIVER OAKS DR
Mailing Address - Street 2:STE 4
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6673
Mailing Address - Country:US
Mailing Address - Phone:843-903-3507
Mailing Address - Fax:843-903-0687
Practice Address - Street 1:4016 RIVER OAKS DR
Practice Address - Street 2:STE 4
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-6673
Practice Address - Country:US
Practice Address - Phone:843-742-7922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor