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General NPI Number Information
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NPI Number | 1245706613
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Entity Type | Organization
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Legal Business Name | EAST GREENBUSH CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 569 COLUMBIA TURNPIKE
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City | EAST GREENBUSH
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State | NY
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Zip | 12061
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Country | US
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Telephone | 518-477-5000
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Fax | 518-477-5009
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Provider Business Mailing Address
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Address Line | 569 COLUMBIA TURNPIKE
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City | EAST GREENBUSH
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State | NY
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Zip | 12061
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Country | US
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Telephone | 518-477-5000
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Fax | 518-477-5009
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | TIMOTHY M KELLY
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Credential | DC
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Telephone | 518-477-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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