Provider Demographics
NPI:1679558001
Name:NELSON, SCOTT W (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
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 1:423 4TH ST SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-3836
Mailing Address - Country:US
Mailing Address - Phone:641-424-0992
Mailing Address - Fax:641-424-0200
Practice Address - Street 1:423 4TH ST SW
Practice Address - Street 2:SUITE A
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3836
Practice Address - Country:US
Practice Address - Phone:641-424-0992
Practice Address - Fax:641-424-0200
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA47882OtherBLUE CROSS & BLUE SHIELD
IA0266940Medicaid
IAU90547Medicare UPIN
IAI6587Medicare ID - Type Unspecified