Provider Demographics
NPI:1487038436
Name:NELSON, KIRSTEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 FRANCE AVE S STE 220
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4762
Mailing Address - Country:US
Mailing Address - Phone:612-200-9993
Mailing Address - Fax:
Practice Address - Street 1:7550 FRANCE AVE S STE 220
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4762
Practice Address - Country:US
Practice Address - Phone:612-200-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1487038436Medicaid