Provider Demographics
NPI:1932134715
Name:NIELSEN, MICHAEL RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:NIELSEN
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:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:MCCOOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-0567
Mailing Address - Country:US
Mailing Address - Phone:308-345-2995
Mailing Address - Fax:308-345-2996
Practice Address - Street 1:114 W C ST
Practice Address - Street 2:
Practice Address - City:MCCOOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3612
Practice Address - Country:US
Practice Address - Phone:308-345-2995
Practice Address - Fax:308-345-2996
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025812900Medicaid
NE27285OtherBLUE CROSS BLUE SHIELD
NENA1404Medicare PIN
NE10025812900Medicaid