Provider Demographics
NPI:1679785331
Name:FECHTER, SCOTT THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:THOMAS
Last Name:FECHTER
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 1:2550 US 1 S
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6194
Mailing Address - Country:US
Mailing Address - Phone:904-823-8833
Mailing Address - Fax:904-823-9394
Practice Address - Street 1:2550 US 1 S
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6194
Practice Address - Country:US
Practice Address - Phone:904-823-8833
Practice Address - Fax:904-823-9394
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2800144-00Medicaid
FLU98899Medicare UPIN
FL88886ZMedicare ID - Type Unspecified