Provider Demographics
NPI:1972546919
Name:SCOTT, JOSEF HEYTVELT (DC)
Entity type:Individual
Prefix:
First Name:JOSEF
Middle Name:HEYTVELT
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:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-0625
Mailing Address - Country:US
Mailing Address - Phone:360-275-4411
Mailing Address - Fax:360-275-4412
Practice Address - Street 1:131 NE ROY BOAD RD
Practice Address - Street 2:SUITE A
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9601
Practice Address - Country:US
Practice Address - Phone:360-275-4411
Practice Address - Fax:360-275-4412
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH34365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH34365OtherCHIROPRACTIC LICENSE
WA0214853OtherDEPT. OF L&I
8863196Medicare ID - Type Unspecified