Healthcare Provider Details

I. General information

NPI: 1457478315
Provider Name (Legal Business Name): SCOTT ELMER KILMER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SOUTH ST
AUBURN NY
13021-4837
US

IV. Provider business mailing address

109 SOUTH ST
AUBURN NY
13021-4837
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-7732
  • Fax: 315-253-7732
Mailing address:
  • Phone: 315-253-7732
  • Fax: 315-253-7732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberX002334-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: