Provider Demographics
NPI:1124236203
Name:BREMER, SCOTT CHRISTOPHER (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CHRISTOPHER
Last Name:BREMER
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 1:25 JEFFERSON ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5019
Mailing Address - Country:US
Mailing Address - Phone:201-342-0445
Mailing Address - Fax:
Practice Address - Street 1:4116 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3143
Practice Address - Country:US
Practice Address - Phone:718-204-6645
Practice Address - Fax:718-204-2115
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009077-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY645767OtherACN