Provider Demographics
NPI:1578706461
Name:NELSON, LORI BETH (DC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:BETH
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 1:1309 5TH ST
Mailing Address - Street 2:P.O. BOX 182
Mailing Address - City:ORION
Mailing Address - State:IL
Mailing Address - Zip Code:61273-7751
Mailing Address - Country:US
Mailing Address - Phone:309-626-0077
Mailing Address - Fax:
Practice Address - Street 1:1309 5TH ST
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:IL
Practice Address - Zip Code:61273-7751
Practice Address - Country:US
Practice Address - Phone:309-626-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011398111N00000X
IA007182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor