Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 4090 | CO |
NPI | 1225149495 |
---|---|
Provider Name | Dr. Scott J. Tesoro |
First Address | Basalt, CO 81621-8370 |
Second Address | Basalt, CO 81621-8370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |