Provider Demographics
NPI:1023147519
Name:SECREST, SCOTT ELVERSON (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ELVERSON
Last Name:SECREST
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 1:1960 N NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-4505
Mailing Address - Country:US
Mailing Address - Phone:812-376-9348
Mailing Address - Fax:
Practice Address - Street 1:1960 N NATIONAL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-4505
Practice Address - Country:US
Practice Address - Phone:812-376-9348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000458A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor