Provider Demographics
NPI:1871524124
Name:KRISANDA, SCOTT BRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BRIAN
Last Name:KRISANDA
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 1:538 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-3942
Mailing Address - Country:US
Mailing Address - Phone:908-213-9000
Mailing Address - Fax:908-213-9002
Practice Address - Street 1:538 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-3942
Practice Address - Country:US
Practice Address - Phone:908-213-9000
Practice Address - Fax:908-213-9002
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC3814111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ021591Medicare UPIN