Provider Demographics
NPI:1588714620
Name:VANWILPE, SCOTT R (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:VANWILPE
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 1:1222 S 55TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2870 W WALNUT ST STE 3
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-0321
Practice Address - Country:US
Practice Address - Phone:479-636-5322
Practice Address - Fax:479-636-5393
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142426718Medicaid
AR59703Medicare ID - Type UnspecifiedMEDICARE