Provider Demographics
NPI:1740394865
Name:NELSON, TYLER SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:SCOTT
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 1:6919 SURREY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2555
Mailing Address - Country:US
Mailing Address - Phone:910-964-2071
Mailing Address - Fax:
Practice Address - Street 1:5434 YADKIN RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3199
Practice Address - Country:US
Practice Address - Phone:910-860-9119
Practice Address - Fax:910-860-8736
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor