Provider Demographics
NPI:1962826081
Name:PROGRESSIVE CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:PROGRESSIVE CHIROPRACTIC, PLLC
Other - Org Name:LUDWIG FAMILY CHIROPRACTIC, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:LUDWIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-234-1512
Mailing Address - Street 1:109 PARK PL
Mailing Address - Street 2:
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043-4632
Mailing Address - Country:US
Mailing Address - Phone:518-234-1512
Mailing Address - Fax:518-234-0180
Practice Address - Street 1:109 PARK PL
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-4632
Practice Address - Country:US
Practice Address - Phone:518-234-1512
Practice Address - Fax:518-234-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008098-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08089-8WOtherNYS WORKERS COMPENSATION
NYU59569Medicare UPIN
55924BMedicare PIN