Provider Demographics
NPI:1144348095
Name:D.J. SCOTT, D.M., D.C., LLC
Entity type:Organization
Organization Name:D.J. SCOTT, D.M., D.C., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:D.
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DM, DC
Authorized Official - Phone:216-671-5023
Mailing Address - Street 1:17023 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5514
Mailing Address - Country:US
Mailing Address - Phone:216-671-5023
Mailing Address - Fax:216-671-4800
Practice Address - Street 1:17023 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5514
Practice Address - Country:US
Practice Address - Phone:216-671-5023
Practice Address - Fax:216-671-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH456261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSC0385471Medicare ID - Type Unspecified