Provider Demographics
NPI:1063676492
Name:NELSON, RYAN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JAMES
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 1:285 E 100 S
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2636
Mailing Address - Country:US
Mailing Address - Phone:435-789-4483
Mailing Address - Fax:435-789-4488
Practice Address - Street 1:285 E 100 S
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2636
Practice Address - Country:US
Practice Address - Phone:435-789-4483
Practice Address - Fax:435-789-4488
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6983760-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor