Healthcare Provider Details

I. General information

NPI: 1386773992
Provider Name (Legal Business Name): SCOT DAVID KOCIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 HAMILTON BLVD STE 104
ALLENTOWN PA
18106-9654
US

IV. Provider business mailing address

5930 HAMILTON BLVD STE 104
ALLENTOWN PA
18106-9654
US

V. Phone/Fax

Practice location:
  • Phone: 610-965-1414
  • Fax: 610-421-8821
Mailing address:
  • Phone: 610-965-1414
  • Fax: 610-421-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007654-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: