Provider Demographics
NPI:1003110818
Name:NELSON CHIROPRACTIC & REHABILITATION LLC
Entity Type:Organization
Organization Name:NELSON CHIROPRACTIC & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-983-8391
Mailing Address - Street 1:905 W VENTURA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3411
Mailing Address - Country:US
Mailing Address - Phone:863-983-8291
Mailing Address - Fax:863-983-2283
Practice Address - Street 1:905 W VENTURA AVE
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3411
Practice Address - Country:US
Practice Address - Phone:863-983-8391
Practice Address - Fax:863-983-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-08
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9995305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002282701Medicaid