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General NPI Number Information
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NPI Number | 1437192820
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Entity Type | Individual
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Provider Name | KEITH S NUSSBAUM D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 469 ALBANY SHAKER RD
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City | LOUDONVILLE
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State | NY
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Zip | 12211-1586
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Country | US
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Telephone | 518-482-6175
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Fax | 518-459-5134
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Provider Business Mailing Address
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Address Line | 124 GLEN HOLLOW RD
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City | SLINGERLANDS
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State | NY
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Zip | 12159-3718
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Country | US
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Telephone | 518-573-0644
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | X005850-1
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License Number State | NY
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