Provider Demographics
NPI:1508061896
Name:J S NELSON P C
Entity Type:Organization
Organization Name:J S NELSON P C
Other - Org Name:NELSON CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-642-5196
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-0127
Mailing Address - Country:US
Mailing Address - Phone:605-642-5196
Mailing Address - Fax:605-642-4409
Practice Address - Street 1:1930 NORTH AVE
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2913
Practice Address - Country:US
Practice Address - Phone:605-642-5196
Practice Address - Fax:605-642-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS3089OtherGROUP
SD7600270Medicaid
SD7600270Medicaid
SDS3089OtherGROUP