Provider Demographics
NPI:1609902147
Name:GREGORC, SCOTT ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANTHONY
Last Name:GREGORC
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 1:10 HIGGINS HWY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1437
Mailing Address - Country:US
Mailing Address - Phone:860-450-1135
Mailing Address - Fax:860-450-0702
Practice Address - Street 1:10 HIGGINS HWY
Practice Address - Street 2:SUITE 7
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1437
Practice Address - Country:US
Practice Address - Phone:860-450-1135
Practice Address - Fax:860-450-0702
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001589CT01OtherANTHEM BCBS