=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932168465
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT M CARUSO D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2006
-----------------------------------------------------
Last Update Date | 08/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 897 ROUTE 910 SUITE 103
-----------------------------------------------------
City | INDIANOLA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15051-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-767-5650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 775
-----------------------------------------------------
City | INDIANOLA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15051-0775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-767-5650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC007220L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------