Provider Demographics
NPI:1447318886
Name:SCOTT, DAVID CLAYTON (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLAYTON
Last Name:SCOTT
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 1:2805 RICHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6458
Mailing Address - Country:US
Mailing Address - Phone:608-318-3411
Mailing Address - Fax:866-545-3493
Practice Address - Street 1:2923 MARKETPLACE DR
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-5319
Practice Address - Country:US
Practice Address - Phone:608-318-3411
Practice Address - Fax:866-545-3493
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3980-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38954800Medicaid
WI113724119012OtherBLUE CROSS BLUE SHIELD
WI38954800Medicaid
U64328Medicare UPIN