Provider Demographics
NPI:1649375346
Name:NIELSON, PHILIP EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:EDWARD
Last Name:NIELSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 FOUNTAIN VALLEY DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-5336
Mailing Address - Country:US
Mailing Address - Phone:865-922-5555
Mailing Address - Fax:865-922-5554
Practice Address - Street 1:4010 FOUNTAIN VALLEY DR
Practice Address - Street 2:SUITE 3
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918
Practice Address - Country:US
Practice Address - Phone:865-922-5555
Practice Address - Fax:865-922-5554
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4440011OtherUHC
2006622OtherBCBS
3675614Medicare ID - Type Unspecified
U09818Medicare UPIN