Provider Demographics
NPI:1932180874
Name:GILLIS, SCOTT I (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:I
Last Name:GILLIS
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 1:406 N EUFAULA AVE
Mailing Address - Street 2:APT E1
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1549
Mailing Address - Country:US
Mailing Address - Phone:334-687-6482
Mailing Address - Fax:
Practice Address - Street 1:129 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1626
Practice Address - Country:US
Practice Address - Phone:334-687-3855
Practice Address - Fax:334-687-0622
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2064111N00000X
GACHIR007511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU97140Medicare UPIN