Provider Demographics
NPI:1265683973
Name:NATHANSON, HAYLEY AUDRA (DC)
Entity Type:Individual
Prefix:DR
First Name:HAYLEY
Middle Name:AUDRA
Last Name:NATHANSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ORCHARD CT
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-7017
Mailing Address - Country:US
Mailing Address - Phone:845-694-8573
Mailing Address - Fax:
Practice Address - Street 1:817 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-6314
Practice Address - Country:US
Practice Address - Phone:845-352-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-007904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor