Healthcare Provider Details

I. General information

NPI: 1205891637
Provider Name (Legal Business Name): SCOTT J CHAFFIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10030 SW 210TH ST
VASHON WA
98070-6584
US

IV. Provider business mailing address

1400 POTTERY AVE
PORT ORCHARD WA
98366-3711
US

V. Phone/Fax

Practice location:
  • Phone: 206-463-3671
  • Fax: 206-463-3613
Mailing address:
  • Phone: 360-895-5000
  • Fax: 360-895-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1226
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1226
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00002175
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: