MEDICARE: SCOTTIE M. ISON, DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH3418	FL

General Provider Information

NPI Number	:	1093192296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTTIE M. ISON, DC

Provider Business Mailing Address
First Line	:	3740 CLEVELAND HEIGHTS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1215
Country	:	US
Telephone Number	:	863-646-5707
Fax Number	:	863-647-5044

Provider Business Practice Location Address
First Line	:	3740 CLEVELAND HEIGHTS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1215
Country	:	US
Telephone Number	:	863-646-5707
Fax Number	:	863-647-5044

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. SCOTTIE MITCHELL ISON
Credential	:	DC
Telephone Number	:	863-646-5707

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	04/27/2015

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Directions to “SCOTTIE M. ISON, DC ” Practice Location

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