Provider Demographics
NPI:1396054185
Name:ROBERT C NELSON, DC, PC
Entity type:Organization
Organization Name:ROBERT C NELSON, DC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACBSP
Authorized Official - Phone:303-205-0501
Mailing Address - Street 1:84 GARRISON ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-7426
Mailing Address - Country:US
Mailing Address - Phone:303-205-0501
Mailing Address - Fax:303-205-0570
Practice Address - Street 1:84 GARRISON ST
Practice Address - Street 2:UNIT B
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-7426
Practice Address - Country:US
Practice Address - Phone:303-205-0501
Practice Address - Fax:303-205-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
350052272OtherRAILROAD MEDICARE
COT60666Medicare UPIN
COC48703Medicare PIN