Provider Demographics
NPI:1699461236
Name:SCOTT, TANNER RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:TANNER
Middle Name:RYAN
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 1:23327 182ND ST
Mailing Address - Street 2:
Mailing Address - City:EDDYVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52553-8181
Mailing Address - Country:US
Mailing Address - Phone:641-777-7071
Mailing Address - Fax:
Practice Address - Street 1:1223 THEATRE DR STE B
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-3778
Practice Address - Country:US
Practice Address - Phone:641-954-9043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor