MEDICARE: DR. SCOTT ELVERSON SECREST D.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	08000458A	IN

General Provider Information

NPI Number	:	1023147519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT ELVERSON SECREST D.C

Provider Business Mailing Address
First Line	:	1960 N NATIONAL RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-4505
Country	:	US
Telephone Number	:	812-376-9348
Fax Number	:

Provider Business Practice Location Address
First Line	:	1960 N NATIONAL RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-4505
Country	:	US
Telephone Number	:	812-376-9348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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