Provider Demographics
NPI:1437269743
Name:NIELSON, LEIF ERIK (DC)
Entity Type:Individual
Prefix:DR
First Name:LEIF
Middle Name:ERIK
Last Name:NIELSON
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 1:380 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT363980-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT87-0619418OtherTAX ID NUMBER
UT000056232Medicare UPIN