MEDICARE: SCOTT CHIROPRACTIC LLC

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	261Q00000X	Clinic/Center	261Q00000X	CA

General Provider Information

NPI Number	:	1427295823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	4432 INGRAHAM ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4404
Country	:	US
Telephone Number	:	858-270-2225
Fax Number	:	858-270-6898

Provider Business Practice Location Address
First Line	:	4432 INGRAHAM ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4404
Country	:	US
Telephone Number	:	858-270-2225
Fax Number	:	858-270-6898

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD ALLEN SCOTT JR.
Credential	:	D.C.
Telephone Number	:	858-270-2225

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	01/07/2009

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