# BAYSIDE CHIROPRACTIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487798591
- **Authorized official:** MELINDA KELLER DC (OWNER)
- **Authorized official phone:** (718) 279-9485

## Contact information

- **Practice address:** 21015 NORTHERN BLVD, BAYSIDE, NY 11361-3239
- **Practice address phone:** (718) 279-9485
- **Practice address fax:** (718) 279-0986
- **Mailing address:** 21015 NORTHERN BLVD, BAYSIDE, NY 11361-3239
- **Mailing address phone:** (718) 279-9485
- **Mailing address fax:** (718) 279-0986

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | X002968-1 | NY | Yes |

## Other

- **Enumeration date:** 02/20/2007
- **Last updated:** 07/09/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | BAZ0S306Y10 | BCBS | NY |