Provider Demographics
NPI:1093712499
Name:NELSON, DEAN A (DC)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:A
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 1:643 S DIXIE HWY
Mailing Address - Street 2:UNIT 2
Mailing Address - City:BEECHER
Mailing Address - State:IL
Mailing Address - Zip Code:60401-3666
Mailing Address - Country:US
Mailing Address - Phone:708-946-3166
Mailing Address - Fax:708-946-2207
Practice Address - Street 1:643 S DIXIE HWY
Practice Address - Street 2:UNIT 2
Practice Address - City:BEECHER
Practice Address - State:IL
Practice Address - Zip Code:60401-3666
Practice Address - Country:US
Practice Address - Phone:708-946-3166
Practice Address - Fax:708-946-2207
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9982028OtherBLUE CROSS BLUE SHIELD
ILT38725Medicare UPIN
IL763740Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER