Provider Demographics
NPI:1265577217
Name:NELSON, WAYNE R (DC, ACRB-L2)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:R
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC, ACRB-L2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-5947
Mailing Address - Country:US
Mailing Address - Phone:541-887-2223
Mailing Address - Fax:541-887-2228
Practice Address - Street 1:335 S SPRING ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-5947
Practice Address - Country:US
Practice Address - Phone:541-887-2223
Practice Address - Fax:541-887-2228
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21451111NR0400X
OR2714111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR166515Medicare PIN
CADC0214510Medicare ID - Type Unspecified