Provider Demographics
NPI:1013941541
Name:NELSON, WILLIAM (D C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 W GREENWAY RD
Mailing Address - Street 2:STE 111
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-3475
Mailing Address - Country:US
Mailing Address - Phone:602-993-0131
Mailing Address - Fax:602-993-7335
Practice Address - Street 1:1855 W GREENWAY RD
Practice Address - Street 2:STE 111
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-3475
Practice Address - Country:US
Practice Address - Phone:602-993-0131
Practice Address - Fax:602-993-7335
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ82512Medicare UPIN