Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1746951202 | UT |
N | 111NX0100X | Occupational Health | 381 | MT |
NPI | 1558448647 |
---|---|
Provider Name | Scott W Bentley |
First Address | Kanab, UT 84741-6161 |
Second Address | Kanab, UT 84741-6161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 11/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T6099 | (02) |