Provider Demographics
NPI:1326229816
Name:NIELSON CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:NIELSON CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIF
Authorized Official - Middle Name:ERIK
Authorized Official - Last Name:NIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-654-5008
Mailing Address - Street 1:380 E MAIN ST
Mailing Address - Street 2:SUITE B-102
Mailing Address - City:MIDWAY
Mailing Address - State:UT
Mailing Address - Zip Code:84049-6801
Mailing Address - Country:US
Mailing Address - Phone:435-654-5008
Mailing Address - Fax:435-654-5328
Practice Address - Street 1:380 E MAIN ST
Practice Address - Street 2:SUITE B-102
Practice Address - City:MIDWAY
Practice Address - State:UT
Practice Address - Zip Code:84049-6801
Practice Address - Country:US
Practice Address - Phone:435-654-5008
Practice Address - Fax:435-654-5328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT363980-1202305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
U74127Medicare UPIN
57850Medicare PIN