Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 038007631 | IL |
NPI | 1265505440 |
---|---|
Provider Name | Robert Campbell Scott |
First Address | Long Grove, IL 60047 |
Second Address | Long Grove, IL 60047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U69542 | (02) | IL |