Provider Demographics
NPI:1396727939
Name:POLITIS, NANCY R (DC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:R
Last Name:POLITIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:R
Other - Last Name:QUEVILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:324 E NEW LENOX RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8311
Mailing Address - Country:US
Mailing Address - Phone:413-499-0985
Mailing Address - Fax:
Practice Address - Street 1:379 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6803
Practice Address - Country:US
Practice Address - Phone:413-443-6337
Practice Address - Fax:413-403-5100
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY37025OtherBLUE CROSS BLUE SHIELD
GA350038917OtherPALMETTO GBA
MAY45498Medicare ID - Type Unspecified
U88691Medicare UPIN