Provider Demographics
NPI:1477566404
Name:NELSON CHIROPRACTIC SYSTEMS, P.C.
Entity Type:Organization
Organization Name:NELSON CHIROPRACTIC SYSTEMS, P.C.
Other - Org Name:NELSON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:N
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-359-9541
Mailing Address - Street 1:2377 CUMBERLAND SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3251
Mailing Address - Country:US
Mailing Address - Phone:563-359-9541
Mailing Address - Fax:563-344-3914
Practice Address - Street 1:2377 CUMBERLAND SQUARE DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3251
Practice Address - Country:US
Practice Address - Phone:563-359-9541
Practice Address - Fax:563-344-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0201796 DR. FRIEMELMedicaid
IA0202619 DR. GALLMedicaid
IA1174788442OtherNPI - DR. GALL
IA48886OtherWELLMARK - DR. TRACI NELS
IA1186874Medicaid
IA1205891868OtherNPI - DR. TRACI NELSON
IA1174788442OtherWELLMARK - DR. GALL
IA1871777474OtherNPI - DR. FRIEMEL
IA72004OtherWELLMARK DR. FRIEMEL
IAI11500002 DR GALLMedicare PIN
IA48886OtherWELLMARK - DR. TRACI NELS
IA0201796 DR. FRIEMELMedicaid
IAI11500001 DR FRIEMELMedicare PIN