Provider Demographics
NPI:1275546665
Name:NELSEN, LEE STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:STEVEN
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 1:305 N ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-2726
Mailing Address - Country:US
Mailing Address - Phone:850-584-7117
Mailing Address - Fax:850-584-7119
Practice Address - Street 1:305 N ORANGE ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2726
Practice Address - Country:US
Practice Address - Phone:850-584-7117
Practice Address - Fax:850-584-7119
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88958Medicare ID - Type Unspecified
FLT56034Medicare UPIN