Healthcare Provider Details

I. General information

NPI: 1316614951
Provider Name (Legal Business Name): AMERISCOTT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 MIRA MESA BLVD STE C
SAN DIEGO CA
92121-4304
US

IV. Provider business mailing address

5955 MIRA MESA BLVD STE C
SAN DIEGO CA
92121-4304
US

V. Phone/Fax

Practice location:
  • Phone: 858-230-6236
  • Fax: 858-408-3654
Mailing address:
  • Phone: 858-230-6236
  • Fax: 858-408-3654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL DEWAYNE SCOTT
Title or Position: MEDICAL DIRECTOR
Credential: DC
Phone: 408-858-7438