Provider Demographics
NPI:1144347816
Name:VANDER WEIT, SCOTT M (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:VANDER WEIT
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 1:290 STONEGATE RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5600
Mailing Address - Country:US
Mailing Address - Phone:847-658-8866
Mailing Address - Fax:847-652-1253
Practice Address - Street 1:290 STONEGATE RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5600
Practice Address - Country:US
Practice Address - Phone:847-658-8866
Practice Address - Fax:847-652-1253
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor