Healthcare Provider Details

I. General information

NPI: 1467760397
Provider Name (Legal Business Name): SCOTT FOLSOM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 S RAINBOW ST STE 1
WASILLA AK
99629
US

IV. Provider business mailing address

1150 S COLONY WAY STE 3 PMB 226
PALMER AK
99645
US

V. Phone/Fax

Practice location:
  • Phone: 907-892-7246
  • Fax: 907-892-7226
Mailing address:
  • Phone: 907-892-7246
  • Fax: 907-892-7226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11600
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number577
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: