Provider Demographics
NPI:1922018175
Name:WADE, SCOTT B (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:B
Last Name:WADE
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 1:6790 THRUSH DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8385
Mailing Address - Country:US
Mailing Address - Phone:614-833-0563
Mailing Address - Fax:614-833-0916
Practice Address - Street 1:6790 THRUSH DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8385
Practice Address - Country:US
Practice Address - Phone:614-833-0563
Practice Address - Fax:614-833-0916
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0930845Medicaid
0733261Medicare ID - Type Unspecified
OH0930845Medicaid