Provider Demographics
NPI:1528044278
Name:NELSON, JILL (DC)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:HOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:627 S FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-2177
Mailing Address - Country:US
Mailing Address - Phone:815-588-1110
Mailing Address - Fax:
Practice Address - Street 1:617 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-2745
Practice Address - Country:US
Practice Address - Phone:417-532-2986
Practice Address - Fax:417-532-2271
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008152111N00000X
MO2022024301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9921349OtherBCBS
IL1528044278OtherNPI
IL364362224OtherFEIN
IL9921349OtherBCBS
IL364362224OtherFEIN