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General NPI Number Information
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NPI Number | 1336328228
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Entity Type | Organization
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Legal Business Name | PROACTIVE CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 1539 CRESCENT RD
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City | CLIFTON PARK
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State | NY
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Zip | 12065-7701
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Country | US
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Telephone | 518-373-9999
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Fax | 518-373-8887
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Provider Business Mailing Address
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Address Line | 1539 CRESCENT RD
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City | CLIFTON PARK
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State | NY
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Zip | 12065-7701
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Country | US
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Telephone | 518-373-9999
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Fax | 518-373-8887
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Authorized Official
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Title or Position | MEMBER
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Name | DR. CRAIG A NELSON
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Credential | DC
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Telephone | 518-373-9999
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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 | X009691
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X008963
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X010445
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License Number State | NY
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