Provider Demographics
NPI:1740282920
Name:NIELSEN, DOUGLAS E (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:E
Last Name:NIELSEN
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 1:1315 GOLF COURSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1548
Mailing Address - Country:US
Mailing Address - Phone:712-476-2841
Mailing Address - Fax:712-476-5085
Practice Address - Street 1:1315 GOLF COURSE RD
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1548
Practice Address - Country:US
Practice Address - Phone:712-476-2841
Practice Address - Fax:712-476-5085
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
21559OtherSIOUX VALLEY HEALTH SYSTE
IA0271817Medicaid
IA27181OtherBLUE CROSS BLUE SHIELD
IA0271817Medicaid
IA27181Medicare PIN