Healthcare Provider Details

I. General information

NPI: 1851503791
Provider Name (Legal Business Name): SCOTT P. WALDEIS, D.C., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S MAIN ST
NAPLES NY
14512-9293
US

IV. Provider business mailing address

130 S MAIN ST PO BOX 220
NAPLES NY
14512-9293
US

V. Phone/Fax

Practice location:
  • Phone: 585-374-2670
  • Fax: 585-374-2682
Mailing address:
  • Phone: 585-374-2670
  • Fax: 585-374-2682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: SCOTT P WALDEIS
Title or Position: OWNER
Credential: DC
Phone: 585-374-2670