Provider Demographics
NPI:1487626735
Name:NELSON, MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
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:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:LARCHWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51241-0081
Mailing Address - Country:US
Mailing Address - Phone:712-477-2260
Mailing Address - Fax:712-477-2260
Practice Address - Street 1:835 EDGERLY ST.
Practice Address - Street 2:
Practice Address - City:LARCHWOOD
Practice Address - State:IA
Practice Address - Zip Code:51241-0081
Practice Address - Country:US
Practice Address - Phone:712-477-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
I8620Medicare UPIN
IAI8620Medicare ID - Type Unspecified