Provider Demographics
NPI:1770689820
Name:NELSON, THOMAS HAMLIN (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HAMLIN
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:HAMLIN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:515 19TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-5274
Mailing Address - Country:US
Mailing Address - Phone:320-235-2720
Mailing Address - Fax:
Practice Address - Street 1:515 19TH AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-5274
Practice Address - Country:US
Practice Address - Phone:320-235-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WICJ7404OtherRAILROAD MEDICARE GROUP
WI350045777OtherRAILROAD MEDICARE
WI38893500Medicaid
T85002Medicare UPIN
WI000170410Medicare ID - Type Unspecified