Healthcare Provider Details

I. General information

NPI: 1003976549
Provider Name (Legal Business Name): SCOTT VARLEY LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 FLETCHER DRIVE SUITE 304
ELGIN IL
60123-4900
US

IV. Provider business mailing address

750 FLETCHER DR SUITE 304
ELGIN IL
60123-4703
US

V. Phone/Fax

Practice location:
  • Phone: 847-888-3131
  • Fax: 847-888-3359
Mailing address:
  • Phone: 847-888-3131
  • Fax: 847-888-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-003722
License Number StateIL

VIII. Authorized Official

Name: SCOTT M VARLEY
Title or Position: PRESIDENT
Credential: DC
Phone: 847-888-3131