Provider Demographics
NPI:1770322653
Name:DR. SHANE SCOTT, SC CHIROPRACTIC INC.
Entity type:Organization
Organization Name:DR. SHANE SCOTT, SC CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC,
Authorized Official - Phone:714-585-3000
Mailing Address - Street 1:13071 BROOKHURST ST STE 110
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1047
Mailing Address - Country:US
Mailing Address - Phone:714-839-8144
Mailing Address - Fax:714-908-2328
Practice Address - Street 1:13071 BROOKHURST ST STE 110
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1047
Practice Address - Country:US
Practice Address - Phone:714-839-8144
Practice Address - Fax:714-908-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA24217OtherBOARD OF CHIROPRACTIC EXAMINERS