Provider Demographics
NPI:1386973584
Name:NANCY BRONSTEIN
Entity type:Organization
Organization Name:NANCY BRONSTEIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-528-2948
Mailing Address - Street 1:15 MAHAIWE ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1901
Mailing Address - Country:US
Mailing Address - Phone:413-528-2948
Mailing Address - Fax:
Practice Address - Street 1:15 MAHAIWE ST
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1901
Practice Address - Country:US
Practice Address - Phone:413-528-2948
Practice Address - Fax:413-528-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA430111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1295721660OtherNPI
MA1427285337OtherNPI
MA1295721660OtherNPI