Provider Demographics
NPI:1366634602
Name:NELSON, CRAIG BRADLEY (DC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:BRADLEY
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 1:12309 GOLD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2760
Mailing Address - Country:US
Mailing Address - Phone:402-334-1200
Mailing Address - Fax:402-334-0998
Practice Address - Street 1:12309 GOLD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2760
Practice Address - Country:US
Practice Address - Phone:402-334-1200
Practice Address - Fax:402-334-0998
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081351800Medicaid
NE271740Medicare PIN
NET71368Medicare UPIN