Provider Demographics
NPI:1073659850
Name:NELIN, MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NELIN
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 1:1970 ROUTE 112 STE 6
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2300
Mailing Address - Country:US
Mailing Address - Phone:631-451-1515
Mailing Address - Fax:631-451-1616
Practice Address - Street 1:1970 ROUTE 112 STE 6
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2300
Practice Address - Country:US
Practice Address - Phone:631-451-1515
Practice Address - Fax:631-451-1616
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009263-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3560042-001OtherCIGNA
NY5899463OtherGHI
NYSF0003053OtherSELECTPRO
NY95674OtherVYTRA
NYAA50689AOtherMDNY
NYP2174322OtherOXFORD
NY7918040OtherAETNA
NY990089OtherEMPIRE HEIRTAGE
NYX7B15OtherEMPIRE BCBS
NY990089OtherEMPIRE HEIRTAGE
NYX7B15OtherEMPIRE BCBS