Provider Demographics
NPI:1922109669
Name:GILLMAN, SCOTT FORD (DC DAC BSP)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:FORD
Last Name:GILLMAN
Suffix:
Gender:M
Credentials:DC DAC BSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W CENTRAL ST STE 220
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3716
Mailing Address - Country:US
Mailing Address - Phone:508-650-1091
Mailing Address - Fax:508-650-1563
Practice Address - Street 1:209 W CENTRAL ST STE 220
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3716
Practice Address - Country:US
Practice Address - Phone:508-650-1091
Practice Address - Fax:508-650-1563
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1610309Medicaid
MAY36073Medicare ID - Type Unspecified