Provider Demographics
NPI:1962421362
Name:SCOTT, ROGER PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:PAUL
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 1:27141 BASELINE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-3126
Mailing Address - Country:US
Mailing Address - Phone:909-425-0148
Mailing Address - Fax:909-425-0174
Practice Address - Street 1:27141 BASELINE ST STE 5
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-3126
Practice Address - Country:US
Practice Address - Phone:909-425-0148
Practice Address - Fax:909-425-0174
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24595111N00000X
AL1720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0245950Medicare ID - Type Unspecified
CAU85044Medicare UPIN