Provider Demographics
NPI:1700854312
Name:NELSON, SHAWN PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:PETER
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 1:660 COOK RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2710
Mailing Address - Country:US
Mailing Address - Phone:586-940-0294
Mailing Address - Fax:949-404-8415
Practice Address - Street 1:27200 HARPER AVE STE B
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1909
Practice Address - Country:US
Practice Address - Phone:586-940-0294
Practice Address - Fax:949-404-8415
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISN008562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OE07214OtherBCBS OF MICHIGAN
MI4431562Medicaid
MI1700854312OtherBLUE CARE NETWORK
MISN008562OtherLICENSE
MI95OF373730OtherGROUP BCBS
MI4508194Medicaid
MI95OE053910OtherBCBS