MEDICARE: SCOTT CHIROPRACTIC CENTER INC

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	L0643329	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	103310600	OTHER	WA	FEDERAL LABOR AND INDUSTR
3	2433MA	OTHER	WA	ASURIS
4	0157424	OTHER	WA	LABOR AND INDUSTRIES

General Provider Information

NPI Number	:	1285859298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT CHIROPRACTIC CENTER INC

Provider Business Mailing Address
First Line	:	5625 N WALL ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-6435
Country	:	US
Telephone Number	:	509-482-1982
Fax Number	:	509-482-1983

Provider Business Practice Location Address
First Line	:	5625 N WALL ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-6435
Country	:	US
Telephone Number	:	509-482-1982
Fax Number	:	509-482-1983

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT MAYSTROVICH
Credential	:	DC
Telephone Number	:	509-482-1982

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	04/11/2011

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