Provider Demographics
NPI:1396939872
Name:NIELSEN, EA (DC)
Entity type:Individual
Prefix:
First Name:EA
Middle Name:
Last Name:NIELSEN
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 1:2971 SALEM DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5501
Mailing Address - Country:US
Mailing Address - Phone:408-835-9803
Mailing Address - Fax:
Practice Address - Street 1:3591 STEVENS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1047
Practice Address - Country:US
Practice Address - Phone:408-835-9803
Practice Address - Fax:408-241-1777
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD.C.23618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor