Provider Demographics
NPI:1730262957
Name:SCOTT, MATTHEW WILSON (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WILSON
Last Name:SCOTT
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 1:112 WHISCONIER ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-3434
Mailing Address - Country:US
Mailing Address - Phone:203-775-4968
Mailing Address - Fax:203-740-9292
Practice Address - Street 1:112 WHISCONIER ROAD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-3434
Practice Address - Country:US
Practice Address - Phone:203-775-4968
Practice Address - Fax:203-740-9292
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
10449833OtherNCQA
35000167Medicare ID - Type Unspecified