Provider Demographics
NPI:1730246349
Name:MACIVER, SCOTT EDWARD (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:EDWARD
Last Name:MACIVER
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 1:171 MAIN ST
Mailing Address - Street 2:STE B103
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721
Mailing Address - Country:US
Mailing Address - Phone:508-881-7766
Mailing Address - Fax:508-881-0441
Practice Address - Street 1:171 MAIN ST
Practice Address - Street 2:STE B103
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721
Practice Address - Country:US
Practice Address - Phone:508-881-7766
Practice Address - Fax:508-881-0441
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH1963111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36482OtherBCBS
U63907Medicare UPIN
Y45132Medicare ID - Type Unspecified