Provider Demographics
NPI:1144346263
Name:OSWALD, SCOTT THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:THOMAS
Last Name:OSWALD
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:PO BOX 490005
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-0005
Mailing Address - Country:US
Mailing Address - Phone:763-784-3004
Mailing Address - Fax:763-780-3004
Practice Address - Street 1:10130 DAVENPORT ST NE
Practice Address - Street 2:SUITE 180
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4776
Practice Address - Country:US
Practice Address - Phone:763-784-3004
Practice Address - Fax:763-780-3004
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor