MEDICARE: DR. LARISA SUSAN SCOTT 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	CH11335	FL

General Provider Information

NPI Number	:	1467857037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARISA SUSAN SCOTT D.C.

Provider Business Mailing Address
First Line	:	1100 TOWN PLAZA CT
Second Line	:	STE 1020
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-6231
Country	:	US
Telephone Number	:	407-901-7704
Fax Number	:	407-288-8582

Provider Business Practice Location Address
First Line	:	1100 TOWN PLAZA CT
Second Line	:	STE 1020
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-6231
Country	:	US
Telephone Number	:	407-901-7704
Fax Number	:	407-288-8582

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

Provider Enumeration Date	:	10/25/2014
Last Update Date	:	05/27/2020

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