Provider Demographics
NPI:1548355787
Name:PEARSON, SCOT A (DC)
Entity type:Individual
Prefix:DR
First Name:SCOT
Middle Name:A
Last Name:PEARSON
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 1:4444 W 76TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5181
Mailing Address - Country:US
Mailing Address - Phone:952-835-4772
Mailing Address - Fax:952-835-4604
Practice Address - Street 1:4444 W 76TH ST STE 100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5181
Practice Address - Country:US
Practice Address - Phone:952-835-4772
Practice Address - Fax:952-835-4604
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND542111N00000X
MN5017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1548355787Medicaid
ND17508Medicaid
MN1548355787Medicaid
MN20286Medicare PIN
MNU30992Medicare UPIN
NDU30992Medicare UPIN