Provider Demographics
NPI:1356440283
Name:NELSON, KEVIN RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:RICHARD
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 1:309 LABREE AVE N STE 2
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-2020
Mailing Address - Country:US
Mailing Address - Phone:218-681-1565
Mailing Address - Fax:
Practice Address - Street 1:309 N LABREE
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-1912
Practice Address - Country:US
Practice Address - Phone:218-681-1565
Practice Address - Fax:218-681-1946
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4K044THOtherBLUE CROSS BLUE SHIELD
MN822797011671OtherPREFERRED ONE
MN350002527Medicare ID - Type Unspecified