Provider Demographics
NPI:1982695045
Name:NELSON, ANNE MARIE MCDERMOTT (DC)
Entity Type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:MCDERMOTT
Last Name:NELSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ANNE MARIE
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1539 CRESCENT RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-7701
Mailing Address - Country:US
Mailing Address - Phone:518-373-9999
Mailing Address - Fax:518-373-8887
Practice Address - Street 1:1539 CRESCENT RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-7701
Practice Address - Country:US
Practice Address - Phone:518-373-9999
Practice Address - Fax:518-373-8887
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU86603Medicare UPIN
NYDD3126Medicare PIN