Provider Demographics
NPI:1871566232
Name:FULLER, SCOTT EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDWARD
Last Name:FULLER
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 1:3 BALDWIN GREEN CMN STE 207
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1869
Mailing Address - Country:US
Mailing Address - Phone:781-933-3332
Mailing Address - Fax:781-933-2225
Practice Address - Street 1:3 BALDWIN GREEN CMN STE 207
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1869
Practice Address - Country:US
Practice Address - Phone:781-933-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH1564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1611577OtherMASSHEALTH
MA4494653OtherAETNA
MAY36107OtherBCBS MA
MA1001665OtherAMERICAN SPECIALTY HEALTH
MA0027013OtherCIGNA
MA4494653OtherPRIVATE HEALTH CARE SYSTEMS
MAAA127819OtherHARVARD PILGRIM
MAY36107OtherBCBS MA
MAY36107Medicare PIN