Provider Demographics
NPI:1336281641
Name:NELSON, MICHAELL KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAELL
Middle Name:KEITH
Last Name:NELSON
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 1:27322 CALLE ARROYO STE A
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-6761
Mailing Address - Country:US
Mailing Address - Phone:949-493-7070
Mailing Address - Fax:
Practice Address - Street 1:27322 CALLE ARROYO STE A
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-6761
Practice Address - Country:US
Practice Address - Phone:949-493-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16013111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT82618Medicare ID - Type Unspecified