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General NPI Number Information
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NPI Number | 1063636371
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Entity Type | Organization
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Legal Business Name | DR. SCOTT SOUTH CORONA CHIROPRACTIC CENTER INC.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 4260 CENTRAL AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2937
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Country | US
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Telephone | 951-686-5040
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Fax | 951-686-5049
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Provider Business Mailing Address
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Address Line | 4260 CENTRAL AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2937
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Country | US
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Telephone | 951-686-5040
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Fax | 951-686-5049
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Authorized Official
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Title or Position | OWNER, CLINICIAN
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Name | DR. ROBERT JEFFERY SCOTT
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Credential | D.C.
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Telephone | 951-686-5040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC26137
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License Number State | CA
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