Provider Demographics
NPI:1356675896
Name:NELSON, CHRIS J (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:J
Last Name:NELSON
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 6TH ST SW APT 2
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-3041
Mailing Address - Country:US
Mailing Address - Phone:402-250-7743
Mailing Address - Fax:
Practice Address - Street 1:2351 HUDSON ROAD
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613
Practice Address - Country:US
Practice Address - Phone:402-250-7743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0007162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer