Provider Demographics
NPI:1306025952
Name:NIELSEN, MONTY LANE (DC)
Entity Type:Individual
Prefix:DR
First Name:MONTY
Middle Name:LANE
Last Name:NIELSEN
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:PO BOX 2479
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93447-2479
Mailing Address - Country:US
Mailing Address - Phone:805-423-7654
Mailing Address - Fax:805-239-2373
Practice Address - Street 1:5855 CAPISTRANO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-7215
Practice Address - Country:US
Practice Address - Phone:805-423-7654
Practice Address - Fax:805-239-2373
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor