Provider Demographics
NPI:1699837195
Name:ALBANY CENTRAL CHIROPRACTIC
Entity Type:Organization
Organization Name:ALBANY CENTRAL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:BERNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-465-3331
Mailing Address - Street 1:879 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3321
Mailing Address - Country:US
Mailing Address - Phone:518-465-3331
Mailing Address - Fax:518-462-6697
Practice Address - Street 1:879 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3321
Practice Address - Country:US
Practice Address - Phone:518-465-3331
Practice Address - Fax:518-462-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336167683OtherINDIVIDUAL NPI NUMBER
NYT26595Medicare UPIN
NY39320BMedicare ID - Type UnspecifiedMEDICARE NUMBER