Provider Demographics
NPI:1790871309
Name:NEVIUS, MICHAEL SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:NEVIUS
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 1:1733 TONI CT
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-7007
Mailing Address - Country:US
Mailing Address - Phone:916-300-7035
Mailing Address - Fax:
Practice Address - Street 1:931 JACKS VALLEY RD
Practice Address - Street 2:STE D
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89705-6957
Practice Address - Country:US
Practice Address - Phone:916-872-1120
Practice Address - Fax:916-872-1125
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01689111N00000X
CA23335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0233350OtherMEDICARE PTAN
CADC0233350OtherMEDICARE PTAN