Provider Demographics
NPI:1215014626
Name:NELSEN, NELS (DC)
Entity Type:Individual
Prefix:DR
First Name:NELS
Middle Name:
Last Name:NELSEN
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 1:1006 E ASH ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-3808
Mailing Address - Country:US
Mailing Address - Phone:919-736-9222
Mailing Address - Fax:919-736-9005
Practice Address - Street 1:1006 E ASH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3808
Practice Address - Country:US
Practice Address - Phone:919-736-9222
Practice Address - Fax:919-736-9005
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1895111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085WFOtherBCBS
NC8908661Medicaid
NC2449131Medicare ID - Type UnspecifiedMEDICARE
NC085WFOtherBCBS