Provider Demographics
NPI:1689623423
Name:NIELSEN, GREGG ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:ERIC
Last Name:NIELSEN
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 1:505 ABER DR
Mailing Address - Street 2:P.O. BOX 86
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-4401
Mailing Address - Country:US
Mailing Address - Phone:262-534-3767
Mailing Address - Fax:262-534-2363
Practice Address - Street 1:505 ABER DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-4401
Practice Address - Country:US
Practice Address - Phone:262-534-3767
Practice Address - Fax:262-534-2363
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor