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General NPI Number Information
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NPI Number | 1467720136
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Entity Type | Organization
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Legal Business Name | JJM CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 1756 UNION ST.
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City | NISKAYUNA
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State | NY
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Zip | 12309
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Country | US
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Telephone | 518-346-2225
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Fax | 518-346-3197
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Provider Business Mailing Address
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Address Line | 1756 UNION STREET
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City | NISKAYUNA
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State | NY
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Zip | 12309
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Country | US
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Telephone | 518-346-2225
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Fax | 518-346-3197
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Authorized Official
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Title or Position | OWNER
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Name | GERALD BRESCIA
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Credential | D.C.
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Telephone | 518-346-2225
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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 | X007787
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License Number State | NY
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