Healthcare Provider Details

I. General information

NPI: 1679695878
Provider Name (Legal Business Name): DOUGLAS EDWARD SCOTT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3734 SOUTH AVE STE A
SPRINGFIELD MO
65807-5291
US

IV. Provider business mailing address

3734 SOUTH AVE STE A
SPRINGFIELD MO
65807-5291
US

V. Phone/Fax

Practice location:
  • Phone: 417-862-2633
  • Fax: 417-866-0243
Mailing address:
  • Phone: 417-862-2633
  • Fax: 417-866-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1999134951
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: