Provider Demographics
NPI:1851503791
Name:SCOTT P. WALDEIS, D.C., LLC
Entity type:Organization
Organization Name:SCOTT P. WALDEIS, D.C., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALDEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-374-2670
Mailing Address - Street 1:130 S MAIN ST
Mailing Address - Street 2:PO BOX 220
Mailing Address - City:NAPLES
Mailing Address - State:NY
Mailing Address - Zip Code:14512-9293
Mailing Address - Country:US
Mailing Address - Phone:585-374-2670
Mailing Address - Fax:585-374-2682
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:NY
Practice Address - Zip Code:14512-9293
Practice Address - Country:US
Practice Address - Phone:585-374-2670
Practice Address - Fax:585-374-2682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherFEDERAL TAX ID
NY=========OtherFEDERAL TAX ID