MEDICARE: SCOTT MICHAEL SIEGEL 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	CHIR011160	GA

General Provider Information

NPI Number	:	1194716886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT MICHAEL SIEGEL D.C.

Provider Business Mailing Address
First Line	:	3001 OAK RUN CT
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-8714
Country	:	US
Telephone Number	:	252-259-1443
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 CELEBRATE LIFE PKWY
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30265-8001
Country	:	US
Telephone Number	:	770-400-7028
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	03/26/2025

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