Provider Demographics
NPI:1861521544
Name:EDLIN, SCOTT HOWARD (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:HOWARD
Last Name:EDLIN
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55003-1027
Mailing Address - Country:US
Mailing Address - Phone:651-351-5070
Mailing Address - Fax:651-351-3198
Practice Address - Street 1:210 3RD ST N
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:MN
Practice Address - Zip Code:55003-1027
Practice Address - Country:US
Practice Address - Phone:651-351-5070
Practice Address - Fax:651-351-3198
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor