Healthcare Provider Details

I. General information

NPI: 1760558183
Provider Name (Legal Business Name): SCOTT L HEGSETH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11015 N DALE MABRY HWY STE B STE B
TAMPA FL
33618-3872
US

IV. Provider business mailing address

11015 N DALE MABRY HWY STE B STE B
TAMPA FL
33618-3872
US

V. Phone/Fax

Practice location:
  • Phone: 813-269-2828
  • Fax:
Mailing address:
  • Phone: 813-269-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH3620
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: