Provider Demographics
NPI:1124555024
Name:NUSSBAUM CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:NUSSBAUM CHIROPRACTIC PLLC
Other - Org Name:KEITH S NUSSBAUM
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSIA-MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-482-6175
Mailing Address - Street 1:130 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1418
Mailing Address - Country:US
Mailing Address - Phone:518-482-6175
Mailing Address - Fax:518-459-5134
Practice Address - Street 1:130 EVERETT RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1418
Practice Address - Country:US
Practice Address - Phone:518-482-6175
Practice Address - Fax:518-459-5134
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NUSSBAUM CHIROPRACTIC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005850111NR0200X
NYX007262-3111NR0200X
NY026404-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1447383369OtherNPI
NY1437192820OtherNPI