Provider Demographics
NPI:1972597391
Name:CARMACK, SCOTT JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JAMES
Last Name:CARMACK
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 1841
Mailing Address - Street 2:
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953-1841
Mailing Address - Country:US
Mailing Address - Phone:509-829-6101
Mailing Address - Fax:509-829-6101
Practice Address - Street 1:513 1ST AVE
Practice Address - Street 2:
Practice Address - City:ZILLAH
Practice Address - State:WA
Practice Address - Zip Code:98953-9432
Practice Address - Country:US
Practice Address - Phone:509-829-6101
Practice Address - Fax:509-829-6101
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB29040OtherMEDICARE INDIVIUAL
WAAB29039OtherMEDICARE GROUP
WA2026052Medicaid
WAU87239OtherUPIN