Provider Demographics
NPI:1679695878
Name:SCOTT, DOUGLAS EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EDWARD
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3734 SOUTH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5291
Mailing Address - Country:US
Mailing Address - Phone:417-862-2633
Mailing Address - Fax:417-866-0243
Practice Address - Street 1:3734 SOUTH AVE STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5291
Practice Address - Country:US
Practice Address - Phone:417-862-2633
Practice Address - Fax:417-866-0243
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999134951111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU79389Medicare UPIN
MO000031774Medicare ID - Type Unspecified