Provider Demographics
NPI:1528054590
Name:STINNETTE, SCOTT RYAN (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:RYAN
Last Name:STINNETTE
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 1:2155 E 23RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2457
Mailing Address - Country:US
Mailing Address - Phone:402-721-0336
Mailing Address - Fax:402-721-8672
Practice Address - Street 1:2155 E 23RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2457
Practice Address - Country:US
Practice Address - Phone:402-721-0336
Practice Address - Fax:402-721-8672
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE278473OtherMEDICARE PERFORMING PROVI
NE09517OtherBLUE CROSS BLUE SHIELD
NE100251876-00Medicaid
NE100251876-00Medicaid
NEV03013Medicare UPIN