Provider Demographics
NPI:1932312832
Name:NELSON, LLOYD E (DC)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:E
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 1:2899 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1403
Mailing Address - Country:US
Mailing Address - Phone:541-523-6565
Mailing Address - Fax:
Practice Address - Street 1:2899 10TH ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1403
Practice Address - Country:US
Practice Address - Phone:541-523-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OROOOOQGDBHMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER