MEDICARE: DR. SCOTT DAVID FLETCHER DC

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	877	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010028569	OTHER	ID	REGENCE BLUE SHIELD
2	C2573	OTHER	ID	BLUE CROSS

General Provider Information

NPI Number	:	1265566855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT DAVID FLETCHER DC

Provider Business Mailing Address
First Line	:	5246 N EAGLE RD
Second Line	:	STE 106
City	:	BOISE
State	:	ID
Zip	:	83713-0945
Country	:	US
Telephone Number	:	208-939-3000
Fax Number	:	208-939-3030

Provider Business Practice Location Address
First Line	:	5246 N EAGLE RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-0945
Country	:	US
Telephone Number	:	208-939-3000
Fax Number	:	208-939-3030

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/21/2022

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Directions to “ DR. SCOTT DAVID FLETCHER DC” Practice Location

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