Provider Demographics
NPI:1790782985
Name:NELSON, CHETT E (DC)
Entity Type:Individual
Prefix:
First Name:CHETT
Middle Name:E
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 1:3014 BASHOR RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1704
Mailing Address - Country:US
Mailing Address - Phone:574-533-2531
Mailing Address - Fax:574-533-7788
Practice Address - Street 1:3014 BASHOR RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1704
Practice Address - Country:US
Practice Address - Phone:574-533-2531
Practice Address - Fax:574-533-7788
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001785111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200215730AMedicaid
INP00650817OtherRAILROAD MEDICARE#
IN200215730AMedicaid
INP00650817OtherRAILROAD MEDICARE#