Provider Demographics
NPI:1366431264
Name:GAMERMAN, MARC M (DC)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:M
Last Name:GAMERMAN
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 1:89 W LEE ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6030
Mailing Address - Country:US
Mailing Address - Phone:301-797-3737
Mailing Address - Fax:301-302-7802
Practice Address - Street 1:89 W LEE ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6030
Practice Address - Country:US
Practice Address - Phone:301-797-3737
Practice Address - Fax:301-302-7802
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM273Medicare ID - Type Unspecified