Provider Demographics
NPI:1174704449
Name:NISKAYUNA LIFE CHIROPRACTIC
Entity type:Organization
Organization Name:NISKAYUNA LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GALISH-FRASIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-377-2525
Mailing Address - Street 1:2525 BALLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1023
Mailing Address - Country:US
Mailing Address - Phone:518-377-2525
Mailing Address - Fax:518-346-7576
Practice Address - Street 1:2525 BALLTOWN RD
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-1023
Practice Address - Country:US
Practice Address - Phone:518-377-2525
Practice Address - Fax:518-346-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty