Provider Demographics
NPI:1982697983
Name:NELSON, MICHAEL D (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
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:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-0215
Mailing Address - Country:US
Mailing Address - Phone:815-732-2826
Mailing Address - Fax:815-732-7617
Practice Address - Street 1:1307 W WASHINGTON ST
Practice Address - Street 2:SUITE 115
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-1022
Practice Address - Country:US
Practice Address - Phone:815-732-2826
Practice Address - Fax:815-732-7617
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009841Medicaid
IL038009841Medicaid
ILL96531Medicare ID - Type UnspecifiedMEDICARE NUMBER