MEDICARE: DR. SCOTT ALLAN SHERIDAN 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	CH00034053	WA

General Provider Information

NPI Number	:	1477619427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT ALLAN SHERIDAN DC

Provider Business Mailing Address
First Line	:	9925 214TH AVE E STE C
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-3910
Country	:	US
Telephone Number	:	253-862-6662
Fax Number	:	253-862-5553

Provider Business Practice Location Address
First Line	:	9925 214TH AVE E STE C
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-3910
Country	:	US
Telephone Number	:	253-862-6662
Fax Number	:	253-862-5553

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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