Provider Demographics
NPI:1811012594
Name:NELSON CLINIC AND REHABILITATION CARE PA
Entity Type:Organization
Organization Name:NELSON CLINIC AND REHABILITATION CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-235-2720
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:320-235-2220
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:320-235-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2016-06-07
Deactivation Date:2013-04-25
Deactivation Code:
Reactivation Date:2014-03-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty