Provider Demographics
NPI:1356355853
Name:NELSON, JOHN S (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:J
Other - Middle Name:S
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-0127
Mailing Address - Country:US
Mailing Address - Phone:605-642-5196
Mailing Address - Fax:605-642-4409
Practice Address - Street 1:1930 NORTH AVE
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-0127
Practice Address - Country:US
Practice Address - Phone:605-642-5196
Practice Address - Fax:605-642-4409
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD-555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS3089OtherGROUP
SD7600270Medicaid
SDT66492Medicare UPIN
SDS83998Medicare PIN