NPIMap

Organization Active NPI

Proactive Chiropractic, PLLC

  • Chiropractor
  • Clifton Park, NY
National Provider Identifier
1336328228
Registry record updated Nov 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X010445 Issued in NY
Legal business name
PROACTIVE CHIROPRACTIC, PLLC
Practice address
1539 Crescent Rd
Clifton Park, NY 12065-7701
Phone
(518) 373-9999
Fax
(518) 373-8887
NPI assigned
Oct 29, 2007
Last updated
Nov 7, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Craig A Nelson, DCNPI 1053301481
Title
Member
Phone
(518) 373-9999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X X009691 NY
Chiropractor 111N00000X X010445 NY Primary
Chiropractor 111N00000X X008963 NY

Addresses

Primary practice location

1539 Crescent Rd
Clifton Park, NY 12065-7701

Mailing address

1539 Crescent Rd
Clifton Park, NY 12065-7701
Phone (518) 373-9999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090121000515 NY Part B Supplier - Clinic/Group Practice 4486718319 Receives reassigned benefits from 3 practitioners
Practice locations: Clifton Park, NY

National Provider Directory

National Provider Directory

Locations

1539 Crescent Rd
Clifton Park, NY 12065
Phone (518) 373-9999

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320624000000",
    "number": "1336328228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1539 CRESCENT RD",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120657701",
            "telephone_number": "518-373-9999",
            "fax_number": "518-373-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1539 CRESCENT RD",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120657701",
            "telephone_number": "518-373-9999",
            "fax_number": "518-373-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE CHIROPRACTIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-29",
        "last_updated": "2011-11-07",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "518-373-9999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X009691",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X010445",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X008963",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clifton Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.