Individual
MR. SCOT ALEXANDER WACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMT, NBCA
Contact information
Practice address
109 NAGONABA ST, NORTHPORT, MI 49670
(231) 386-7708
Mailing address
10655 E MELKILD RD, NORTHPORT, MI 49670-9630
(231) 386-7708
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
04/26/2010
Last updated
04/26/2010
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