Provider Demographics
NPI:1790845105
Name:NELSON, ERIC ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALLEN
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 1:289 WHITE HORSE PIKE STE 201
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-2257
Mailing Address - Country:US
Mailing Address - Phone:856-767-8800
Mailing Address - Fax:856-767-8056
Practice Address - Street 1:289 WHITE HORSE PIKE STE 201
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-2257
Practice Address - Country:US
Practice Address - Phone:856-767-8800
Practice Address - Fax:856-767-8056
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28MC00520400111NR0400X
NJ38MC00520400111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7768702Medicaid
NJ017292Medicare ID - Type Unspecified
NJU72014Medicare UPIN