Provider Demographics
NPI:1023146552
Name:CUTHBERT, SCOTT CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CHARLES
Last Name:CUTHBERT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 WEST ABRIENDO AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1870
Mailing Address - Country:US
Mailing Address - Phone:719-544-1468
Mailing Address - Fax:719-543-2357
Practice Address - Street 1:255 WEST ABRIENDO AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1870
Practice Address - Country:US
Practice Address - Phone:719-544-1468
Practice Address - Fax:719-543-2357
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
C48913Medicare ID - Type Unspecified
U66592Medicare UPIN