Provider Demographics
NPI:1720006950
Name:NELSON, TERRY JO (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:JO
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 1:8321 JARBOE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-2115
Mailing Address - Country:US
Mailing Address - Phone:913-220-8584
Mailing Address - Fax:
Practice Address - Street 1:114 W GREGORY BLVD
Practice Address - Street 2:#4
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1148
Practice Address - Country:US
Practice Address - Phone:913-220-8584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2014-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5706111NI0900X
KS01-03843111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU16469Medicare UPIN
MOU16469Medicare UPIN