Individual
DR. SCOTT A VAN DAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1203 28TH ST S STE B, FARGO, ND 58103-8711
(701) 532-5320
(701) 280-2915
Mailing address
1203 28TH ST S STE B, FARGO, ND 58103-8711
(701) 532-5320
(701) 280-2915
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
038008694
IL
111N00000X
Chiropractor
3742
MN
111N00000X
Chiropractor
Primary
747
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1205038023
GROUP
ND
01
—
24468
BCBS ND
ND
01
—
665360
ACN
—
01
—
90M20VA
BCBS MN
MN
Enumeration date
04/04/2006
Last updated
05/28/2019
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