Provider Demographics
NPI:1598836728
Name:NELSON, DAVID PAUL (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 BEMIDJI AVE N
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4333
Mailing Address - Country:US
Mailing Address - Phone:218-751-4936
Mailing Address - Fax:218-751-4939
Practice Address - Street 1:3620 BEMIDJI AVE N
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4333
Practice Address - Country:US
Practice Address - Phone:218-751-4936
Practice Address - Fax:218-751-4939
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0001111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN83326NEOtherBCBS OF MN
MN83326NEOtherBCBS OF MN