Provider Demographics
NPI:1164087052
Name:NELSON, ZACHARY DAVID (DC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DAVID
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ZACHARY
Other - Middle Name:DAVID
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ZACHARY NELSON DC
Mailing Address - Street 1:11279 TALLMADGE WOODS DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-6318
Mailing Address - Country:US
Mailing Address - Phone:616-791-9702
Mailing Address - Fax:616-791-4661
Practice Address - Street 1:11279 TALLMADGE WOODS DR NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-6318
Practice Address - Country:US
Practice Address - Phone:616-791-9702
Practice Address - Fax:616-791-4661
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor