Provider Demographics
NPI:1457478315
Name:KILMER, SCOTT ELMER (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ELMER
Last Name:KILMER
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 1:109 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4837
Mailing Address - Country:US
Mailing Address - Phone:315-253-7732
Mailing Address - Fax:315-253-7732
Practice Address - Street 1:109 SOUTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4837
Practice Address - Country:US
Practice Address - Phone:315-253-7732
Practice Address - Fax:315-253-7732
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002334-1111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT26507Medicare UPIN
NY37979BMedicare ID - Type Unspecified