Upstate Chiro LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

UPSTATE CHIRO LLC

Practice address

127 Main St
Gardiner, NY 12525-5210

Phone

(845) 255-6080

NPI assigned

Jan 20, 2023

Organization subpart

No

Name

Nichole A Smith, DCNPI 1295895381

Title

Owner

Phone

(845) 255-6080

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nichole Ann Smith, D.C.

  • Chiropractor
  • Gardiner, NY
  • NPI 1295895381
  Medicare reassignment NPD Authorized official

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

• Upstate Chiro Llc Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 20, 2023.

{
    "created_epoch": "1674172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674172800000",
    "number": "1346955697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 MAIN ST",
            "city": "GARDINER",
            "state": "NY",
            "postal_code": "125255210",
            "telephone_number": "845-255-6080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 MAIN ST",
            "city": "GARDINER",
            "state": "NY",
            "postal_code": "125255210",
            "telephone_number": "845-255-6080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE CHIRO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-20",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "NICHOLE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-255-6080",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Upstate Chiro Llc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nichole Ann Smith, D.C.
• Richard J Smith, LCSW
• Laura Elizabeth Teetz, MS
• Jessica Temple
• Charles Lee Travis II
• Roseanne Carole Vecchione, R-LCSW

• All providers in Gardiner, NY
• Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2023; 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.