=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649901059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPITAL DISTRICT FAMILY CHIROPRACTIC, PLLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2022
-----------------------------------------------------
Last Update Date | 06/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 COLVIN AVE STE 100
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12206-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-599-0067
-----------------------------------------------------
Fax | 518-599-0256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 59 COPPERFIELD DR
-----------------------------------------------------
City | WATERFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12188-1095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-210-8717
-----------------------------------------------------
Fax | 518-599-0256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RHIANNON CLAUSS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 404-210-8717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------