Provider Demographics
NPI:1477614709
Name:NELSON, WALTER (DC,PC)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 E 100 S
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2636
Mailing Address - Country:US
Mailing Address - Phone:435-789-4483
Mailing Address - Fax:435-789-4488
Practice Address - Street 1:285 E 100 S
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2636
Practice Address - Country:US
Practice Address - Phone:435-789-4483
Practice Address - Fax:435-789-4488
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT149169-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870496123OtherCHICAGO LABORERS HEALTH
UT870496123 001OtherCIGNA
UT870496123 B96840OtherBLUE CROSS BLU SHIELD UT
UT870496123OtherSTANDARD LIFE
UT35281OtherDMBA
UT870496123OtherBANKERS LIFE
UT870496123OtherLIBERTY MUTUIAL
UT107000307101OtherSELECT CARE
UT870496123OtherMAIL HANDELERS
UT870496123OtherPRINCIPAL LIFE
UT870496123OtherGREAT WEST
UT870496123OtherCCNM
UTUT9999OtherMUTUAL OF OMAHA
UT870496123 001OtherCIGNA