Provider Demographics
NPI:1003816489
Name:NELSON, G. THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:G.
Middle Name:THOMAS
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:TWIN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56584-0310
Mailing Address - Country:US
Mailing Address - Phone:218-584-5515
Mailing Address - Fax:218-584-5520
Practice Address - Street 1:NORTH HWY 32
Practice Address - Street 2:
Practice Address - City:TWIN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:56584
Practice Address - Country:US
Practice Address - Phone:218-584-5515
Practice Address - Fax:218-584-5520
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN63573NEOtherBLUE CROSS BLUE SHIELD
MNT65911Medicare UPIN