Provider Demographics
NPI:1063486249
Name:NELSON, BRENT ALLEN (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALLEN
Last Name:NELSON
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 US HWY 60W
Mailing Address - Street 2:
Mailing Address - City:LEDBETTER
Mailing Address - State:KY
Mailing Address - Zip Code:42058
Mailing Address - Country:US
Mailing Address - Phone:270-898-8530
Mailing Address - Fax:270-898-8530
Practice Address - Street 1:1656 US HWY 60W
Practice Address - Street 2:
Practice Address - City:LEDBETTER
Practice Address - State:KY
Practice Address - Zip Code:42058
Practice Address - Country:US
Practice Address - Phone:270-898-8530
Practice Address - Fax:270-898-8530
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
5638229OtherAETNA
KY000000043037OtherBLUECROSS
U54797Medicare UPIN
KY6070201Medicare ID - Type Unspecified