Healthcare Provider Details

I. General information

NPI: 1124555024
Provider Name (Legal Business Name): NUSSBAUM CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 EVERETT RD
ALBANY NY
12205-1418
US

IV. Provider business mailing address

130 EVERETT RD
ALBANY NY
12205-1418
US

V. Phone/Fax

Practice location:
  • Phone: 518-482-6175
  • Fax: 518-459-5134
Mailing address:
  • Phone: 518-482-6175
  • Fax: 518-459-5134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberX007262-3
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number026404-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number005850
License Number StateNY

VIII. Authorized Official

Name: MARY MESSIA-MCBRIDE
Title or Position: OFFICE MANAGER
Credential:
Phone: 518-482-6175