Provider Demographics
NPI:1952380396
Name:NELSON, MICHELLE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:NELSON
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 1:1255 BOYSON LOOP
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1310
Mailing Address - Country:US
Mailing Address - Phone:319-393-4727
Mailing Address - Fax:319-393-4727
Practice Address - Street 1:1255 BOYSON LOOP
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1310
Practice Address - Country:US
Practice Address - Phone:319-393-4727
Practice Address - Fax:319-393-4727
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA44417OtherWELLMARK BLUE CROSS
IA0483073Medicaid
IAI5960Medicare ID - Type UnspecifiedMEDICARE