MEDICARE: SCOTT GAMM D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2002022729	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1023027828	OTHER		GROUP NPI
2	168923	OTHER		BCBS

General Provider Information

NPI Number	:	1164695284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT GAMM D.O.

Provider Business Mailing Address
First Line	:	136 SPRING CREEK RD
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-8623
Country	:	US
Telephone Number	:	417-334-5330
Fax Number	:	417-339-2635

Provider Business Practice Location Address
First Line	:	136 SPRING CREEK RD
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-8623
Country	:	US
Telephone Number	:	417-334-5330
Fax Number	:	417-339-2635

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	04/09/2008

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Directions to “ SCOTT GAMM D.O.” Practice Location

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