Provider Demographics
NPI:1942393533
Name:NELSON, KIRK (DC)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:
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 1:8425 SEASONS PKWY
Mailing Address - Street 2:STE 104B
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4392
Mailing Address - Country:US
Mailing Address - Phone:651-702-7800
Mailing Address - Fax:
Practice Address - Street 1:8425 SEASONS PKWY
Practice Address - Street 2:STE 104B
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4392
Practice Address - Country:US
Practice Address - Phone:651-702-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2173280-00Medicaid
MNU19216Medicare UPIN
MN2173280-00Medicaid