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General NPI Number Information
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NPI Number | 1932283439
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Entity Type | Individual
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Provider Name | DR. DOMINIQUE MATTHEW SCOTT
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 14200 HIGHWAY 92
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City | WOODSTOCK
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State | GA
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Zip | 30188-7139
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Country | US
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Telephone | 677-819-7658
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 549
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City | CHANHASSEN
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State | MN
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Zip | 55317-0549
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Country | US
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Telephone | 310-376-5433
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC25377
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR010268
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License Number State | GA
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