Provider Demographics
NPI:1164538047
Name:GARRY NELSON DC PC
Entity Type:Organization
Organization Name:GARRY NELSON DC PC
Other - Org Name:NELSON & NELSON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-964-2070
Mailing Address - Street 1:1660 S. HORNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5634
Mailing Address - Country:US
Mailing Address - Phone:919-777-9999
Mailing Address - Fax:919-777-9998
Practice Address - Street 1:1660 S. HORNER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5634
Practice Address - Country:US
Practice Address - Phone:919-777-9999
Practice Address - Fax:919-777-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2115111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty