Provider Demographics
NPI:1457461386
Name:NELSON, BARRY I
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:I
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42700 BOB HOPE DR
Mailing Address - Street 2:306
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4434
Mailing Address - Country:US
Mailing Address - Phone:760-346-0082
Mailing Address - Fax:760-341-3071
Practice Address - Street 1:42700 BOB HOPE DR
Practice Address - Street 2:306
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4434
Practice Address - Country:US
Practice Address - Phone:760-346-0082
Practice Address - Fax:760-341-3071
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor