Provider Demographics
NPI:1184735110
Name:NELSEN, LISA M (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:NELSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4233
Mailing Address - Country:US
Mailing Address - Phone:360-676-4488
Mailing Address - Fax:360-647-5587
Practice Address - Street 1:2029 JAMES ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4233
Practice Address - Country:US
Practice Address - Phone:360-676-4488
Practice Address - Fax:360-647-5587
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA248270-001OtherGROUP HEALTH
WA0074308OtherLABOR & INDUSTRIES
WA4542NEOtherBLUE CROSS/BLUE SHIELD
WA0074308OtherLABOR & INDUSTRIES