Provider Demographics
NPI:1538724018
Name:DEANE, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:DEANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-530 MAKALEA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5941
Mailing Address - Country:US
Mailing Address - Phone:323-767-4613
Mailing Address - Fax:
Practice Address - Street 1:91-902 FORT WEAVER RD STE 204
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2261
Practice Address - Country:US
Practice Address - Phone:808-517-4826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor