Healthcare Provider Details

I. General information

NPI: 1134250897
Provider Name (Legal Business Name): SCOTT D. MACLARY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S BROAD ST
LITITZ PA
17543-2602
US

IV. Provider business mailing address

402 S BROAD ST
LITITZ PA
17543-2602
US

V. Phone/Fax

Practice location:
  • Phone: 717-625-2223
  • Fax: 717-625-2210
Mailing address:
  • Phone: 717-625-2223
  • Fax: 717-625-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009479
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: