Provider Demographics
NPI:1851439343
Name:HYDE, NANCY L (DC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:L
Last Name:HYDE
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 1:125 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NY
Mailing Address - Zip Code:13624-1354
Mailing Address - Country:US
Mailing Address - Phone:315-686-4083
Mailing Address - Fax:315-686-4083
Practice Address - Street 1:125 STATE ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NY
Practice Address - Zip Code:13624-1354
Practice Address - Country:US
Practice Address - Phone:315-686-4083
Practice Address - Fax:315-686-4083
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
BB0894Medicare ID - Type Unspecified
BB0894Medicare UPIN
U70616Medicare ID - Type Unspecified