Provider Demographics
NPI:1881689156
Name:NELSON, CARL D (DC)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:D
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 1:968 S ORIOLE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6206
Mailing Address - Country:US
Mailing Address - Phone:757-422-4536
Mailing Address - Fax:757-422-6241
Practice Address - Street 1:968 S ORIOLE DR STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6206
Practice Address - Country:US
Practice Address - Phone:757-422-4536
Practice Address - Fax:757-422-6241
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T21488Medicare UPIN