Provider Demographics
NPI:1942495486
Name:AMERICAN CHIROPRACTIC ENTERPRISE PLLC
Entity Type:Organization
Organization Name:AMERICAN CHIROPRACTIC ENTERPRISE PLLC
Other - Org Name:KB CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-828-3662
Mailing Address - Street 1:322 FAIRVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534
Mailing Address - Country:US
Mailing Address - Phone:518-828-3662
Mailing Address - Fax:581-828-3845
Practice Address - Street 1:322 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1219
Practice Address - Country:US
Practice Address - Phone:518-828-3662
Practice Address - Fax:581-828-3845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010809111N00000X
NYX0109671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty