Provider Demographics
NPI:1760580906
Name:NELSON, ROBERT C (DC, DACBSP)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC, DACBSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 GARRISON ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-7426
Mailing Address - Country:US
Mailing Address - Phone:303-205-0501
Mailing Address - Fax:303-205-0570
Practice Address - Street 1:84 GARRISON ST
Practice Address - Street 2:UNIT B
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-7426
Practice Address - Country:US
Practice Address - Phone:303-205-0501
Practice Address - Fax:303-205-0570
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2664111N00000X
IACERTIFICATE #78111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
COM33684OtherWORK COMP
COM33684OtherWORK COMP
COT60666Medicare UPIN