MEDICARE: SCOTT CLIFFORD SOUCIE 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	4975	CO

General Provider Information

NPI Number	:	1780668582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT CLIFFORD SOUCIE DC

Provider Business Mailing Address
First Line	:	PO BOX 434
Second Line	:
City	:	WELLINGTON
State	:	CO
Zip	:	80549-0434
Country	:	US
Telephone Number	:	970-568-9368
Fax Number	:

Provider Business Practice Location Address
First Line	:	4006 CLEVELAND AVE
Second Line	:	BUILDING B
City	:	WELLINGTON
State	:	CO
Zip	:	80549
Country	:	US
Telephone Number	:	970-568-9368
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/08/2007

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Directions to “ SCOTT CLIFFORD SOUCIE DC” Practice Location

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