Provider Demographics
NPI:1447340674
Name:KIRBY, SCOTTY LEE (DC)
Entity type:Individual
Prefix:MR
First Name:SCOTTY
Middle Name:LEE
Last Name:KIRBY
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 1:23 NORTH SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583
Mailing Address - Country:US
Mailing Address - Phone:931-836-2532
Mailing Address - Fax:931-836-2532
Practice Address - Street 1:23 NORTH SPRING ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583
Practice Address - Country:US
Practice Address - Phone:931-836-2532
Practice Address - Fax:931-836-2532
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN003005346OtherBCBS
TN003005346OtherBCBS
U53941Medicare UPIN