Healthcare Provider Details

I. General information

NPI: 1437192820
Provider Name (Legal Business Name): KEITH S NUSSBAUM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 ALBANY SHAKER RD
LOUDONVILLE NY
12211-1586
US

IV. Provider business mailing address

124 GLEN HOLLOW RD
SLINGERLANDS NY
12159-3718
US

V. Phone/Fax

Practice location:
  • Phone: 518-482-6175
  • Fax: 518-459-5134
Mailing address:
  • Phone: 518-573-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX005850-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: