Provider Demographics
NPI:1356352389
Name:DE POL, SCOTT HOWARD (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:HOWARD
Last Name:DE POL
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 1:1540 BRIERS CHUTE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1185
Mailing Address - Country:US
Mailing Address - Phone:770-442-1686
Mailing Address - Fax:
Practice Address - Street 1:6221 SHALLOWFORD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1971
Practice Address - Country:US
Practice Address - Phone:423-648-2053
Practice Address - Fax:423-648-2164
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007708111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition