=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841315439
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDREW SCOTT CHIROPRACTIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1271 PLEASANT GROVE BLVD SUITE 130
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95747-5882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-791-2010
-----------------------------------------------------
Fax | 916-791-2070
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1271 PLEASANT GROVE BLVD SUITE 130
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95747-5882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-791-2010
-----------------------------------------------------
Fax | 916-791-2070
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ANDREW R SCOTT
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 916-791-2010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC29003
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------