Provider Demographics
NPI:1952458127
Name:NIELSON, CHAD J (DC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:J
Last Name:NIELSON
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 1:260 FALLS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3370
Mailing Address - Country:US
Mailing Address - Phone:208-733-2322
Mailing Address - Fax:208-733-2224
Practice Address - Street 1:260 FALLS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3370
Practice Address - Country:US
Practice Address - Phone:208-733-2322
Practice Address - Fax:208-733-2224
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC4140OtherBLUE CROSS
ID000010147143OtherBLUE SHIELD
ID1675465Medicare ID - Type Unspecified
ID000010147143OtherBLUE SHIELD