Provider Demographics
NPI:1184753402
Name:GREGORY, SCOTT ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANDREW
Last Name:GREGORY
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 1:1400 CHEWS LANDING RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2770
Mailing Address - Country:US
Mailing Address - Phone:856-308-9116
Mailing Address - Fax:856-627-3169
Practice Address - Street 1:1400 CHEWS LANDING RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-2770
Practice Address - Country:US
Practice Address - Phone:856-627-3169
Practice Address - Fax:856-627-3169
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00364400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5232404608OtherCDL MEDICAL EXAMINER (FMCSA)