Healthcare Provider Details

I. General information

NPI: 1811719727
Provider Name (Legal Business Name): SCOLLIE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 W MACARTHUR BLVD STE 600B
SANTA ANA CA
92704-6916
US

IV. Provider business mailing address

3000 W MACARTHUR BLVD STE 600B
SANTA ANA CA
92704-6916
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: --
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: SCOT COLLIE
Title or Position: OWNER
Credential:
Phone: --