Healthcare Provider Details

I. General information

NPI: 1386973584
Provider Name (Legal Business Name): NANCY BRONSTEIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MAHAIWE ST
GREAT BARRINGTON MA
01230-1901
US

IV. Provider business mailing address

15 MAHAIWE ST
GREAT BARRINGTON MA
01230-1901
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-2948
  • Fax: 413-528-5404
Mailing address:
  • Phone: 413-528-2948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number430
License Number StateMA

VIII. Authorized Official

Name: DR. NANCY BRONSTEIN
Title or Position: CLINIC CO-DIRECTOR
Credential:
Phone: 413-528-2948