Provider Demographics
NPI:1689616708
Name:NELSON, GREGORY PAUL (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
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 1:17787 KENWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-9493
Mailing Address - Country:US
Mailing Address - Phone:952-435-3345
Mailing Address - Fax:952-435-8895
Practice Address - Street 1:17787 KENWOOD TRL
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9493
Practice Address - Country:US
Practice Address - Phone:952-435-3345
Practice Address - Fax:952-435-8895
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1848111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN12327NEOtherBCBS
MN230618OtherCHIROCARE