Provider Demographics
NPI:1174562433
Name:HALE, SCOTT C (DC, QME)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:HALE
Suffix:
Gender:M
Credentials:DC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8770
Mailing Address - Country:US
Mailing Address - Phone:530-622-3600
Mailing Address - Fax:530-622-3865
Practice Address - Street 1:2804 MALLARD LN
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8770
Practice Address - Country:US
Practice Address - Phone:530-622-3600
Practice Address - Fax:530-622-3865
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0166810111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0166810OtherCHIROPRACTIC LICENCE #
CAT06234Medicare UPIN