Provider Demographics
NPI:1902355811
Name:SCOTT, FRANK WALTON (L AC)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:WALTON
Last Name:SCOTT
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4421
Mailing Address - Country:US
Mailing Address - Phone:847-791-9214
Mailing Address - Fax:
Practice Address - Street 1:1565 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4421
Practice Address - Country:US
Practice Address - Phone:847-791-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000077171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL198000077OtherILLINOIS LICENSE