Basic Information
Provider Information
NPI: 1952379653
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CALZARETTA
FirstName: SCOTT
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1848
Address2:  
City: NOVATO
State: CA
PostalCode: 949481848
CountryCode: US
TelephoneNumber: 4158979195
FaxNumber: 4158970346
Practice Location
Address1: THREE EMBARCADERO CENTER
Address2: LOBBY LEVEL
City: SAN FRANCISCO
State: CA
PostalCode: 94111
CountryCode: US
TelephoneNumber: 4154952225
FaxNumber: 4154952228
Other Information
ProviderEnumerationDate: 03/09/2006
LastUpdateDate: 07/21/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000XDC0180600CAY Chiropractic ProvidersChiropractor 

No ID Information.


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