Provider Demographics
NPI:1962510230
Name:MICHELLE NELSON CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MICHELLE NELSON CHIROPRACTIC INC
Other - Org Name:NELSON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-393-4727
Mailing Address - Street 1:698 BOYSON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1216
Mailing Address - Country:US
Mailing Address - Phone:319-393-4727
Mailing Address - Fax:319-393-1035
Practice Address - Street 1:698 BOYSON RD STE B
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1216
Practice Address - Country:US
Practice Address - Phone:319-393-4727
Practice Address - Fax:319-393-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0483073Medicaid
IAU89534Medicare UPIN
IAI 5960Medicare ID - Type Unspecified