Provider Demographics
NPI:1801908314
Name:CHERNOV, SCOTADAM JUDAH (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTADAM
Middle Name:JUDAH
Last Name:CHERNOV
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 1:322 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-3011
Mailing Address - Country:US
Mailing Address - Phone:978-281-0049
Mailing Address - Fax:978-282-1537
Practice Address - Street 1:322 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-3011
Practice Address - Country:US
Practice Address - Phone:978-281-0049
Practice Address - Fax:978-282-1537
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2075111N00000X
NYX0083881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA350084OtherHARVARD PILGRIM
765787OtherTUFTS
MAY39202OtherBCBS GROUP #
MAY36454OtherBCBS
MAY45076Medicare ID - Type Unspecified