Provider Demographics
NPI:1912255498
Name:NELSON, ADDISON BLAKE (DC)
Entity Type:Individual
Prefix:DR
First Name:ADDISON
Middle Name:BLAKE
Last Name:NELSON
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 1:722 N FRASER ST STE A
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-3353
Mailing Address - Country:US
Mailing Address - Phone:843-527-4200
Mailing Address - Fax:843-527-4222
Practice Address - Street 1:722 N FRASER ST STE A
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3353
Practice Address - Country:US
Practice Address - Phone:843-527-4200
Practice Address - Fax:843-527-4222
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor